Compositions for weight management

ABSTRACT

Methods and compositions for regulating food intake in a human subject; for improving a compliance of a human subject to caloric restriction; and for reducing a desire of a human subject to consume fats, utilizing H1-receptor agonists that have a pharmacological half-life that allows am efficient treatment regime thereof are disclosed. The methods and compositions can be efficiently used for treating conditions such as overeating, overweight, obesity, binge eating disorder, night eating syndrome, obsessive eating, compulsive eating and bulimia, as well as conditions associated with metabolic derangement such as dyslipidemia and for preventing or reducing weight gain due to factors such as drug use, cessation of smoking, and the like in a human subject.

This application is a continuation of U.S. patent application Ser. No.11/363,332, filed on Feb. 28, 2006, which is a continuation-in-part ofU.S. patent applications Ser. Nos. 11/283,865 and 11/283,928, co-filedon Nov. 22, 2005, each being a continuation-in-part of PCT PatentApplication No. PCT/IL2005/000440, filed on Apr. 21, 2005, which claimsthe benefit of U.S. Provisional Patent Application No. 60/670,290, filedon Apr. 12, 2005 and from Israel Patent Application No. 161595, filed onApr. 22, 2004. The teachings of the above applications are herebyincorporated by reference as if fully set forth herein.

FIELD OF THE INVENTION

The present invention relates to novel compositions and methods forregulating food intake in human subjects and more particularly tocompositions and methods for preventing or treating conditions in whichweight management is beneficial. The present invention further relatesto compositions and methods of preventing or reducing weight gainassociated with drug treatment, smoking cessation and the like.

BACKGROUND OF THE INVENTION

Obesity is a chronic, complex, multi-factorial disease, involvingsocial, cultural, genetic, physiological and psychological components,and is associated with substantially increased morbidity and mortality.Over-nutrition is attributed as the cause of about 400,000 deaths a yearin the USA (Mokdad, 2004), and may considered to be an epidemic. Basedon the body-mass index, defined as the ratio of weight and squaredheight, (ranging normally from 18.5 to 24.9), about one third of theadult population is overweight (an index of from 25 to 29.9), and morethan one quarter is obese (index greater than 30) (National Center forHealth Statistics, 2000). Environmental and behavioral changes broughtabout by economic development and modernization have been linked to therise in global obesity. The environmental factors which foster thetendency toward obesity include lack of physical activity combined withhigh-calorie foods. The prevalence of overweight and obesity isincreasing worldwide at an alarming rate in both developing anddeveloped countries, in children and adults, men and women. The numberof overweight and obese people has continued to increase since 1960, atrend that is not slowing down. Today, 64.5% of adult Americans—about127 million—are categorized as being overweight or obese and nearlyone-third (30.5%)—about 60 million—are obese, as reported in theNational Health and Nutrition Examination Survey (NHANES) by the Centersfor Disease Control and Prevention (CDC).

Obesity significantly increases the risk of illness from about thirtyserious medical conditions and is associated with increases in deathsfrom all-causes. Among these are high blood pressure, diabetes,osteoarthritis, heart disease, stroke, gallbladder disease and cancer ofthe breast, prostate and colon (National Task Force on the Preventionand Treatment of Obesity, 2000). Furthermore, each year, obesity causesat least 300,000 excess deaths in the U.S., being the second leadingcause of unnecessary deaths. Healthcare costs of American adults withobesity amount to approximately 100 billion dollars.

Weight gain has also been found to occur as a result of various factors,including, for example, use of certain drugs, cessation of smoking, andadvent of a holiday season.

Drugs which are known to cause weight gain include antipsychotics,particularly atypical antipsychotics; antidepressants, particularly thetricyclic antidepressants; mood-stabilizers; calcium channel blockers;anti-convulsants; proton pump inhibitors; antidiabetic agents;antihypertensives; and hormones. Certain selective serotonin-reuptakeinhibitors (SSRIs) also have an effect on weight gain, although otherSSRIs, such as, sertraline, sibutramine and fluoxetine, often have theopposite effect, and are, in fact, used as appetite suppressants.

Weight gain associated with use of certain drugs may significantlyaffect patient compliance with the drug administration regime.

Certain drug categories, such as the SSRIs and tricyclicantidepressants, cause food cravings. Furthermore, such drugs maystimulate appetite by blocking of histamine receptors. For example, ithas recently been shown that atypical antipsychotics, such as olanzapineand ciozapine, as well as tricyclic and tetracylic antidepressants, suchas amitriptyline and mirtazapine, respectively, which are potent H₁antagonists, have a high propensity to induce weight gain (Wirshing,1999).

Atypical antipsychotics have been frequently cited as causing a higherincrease in weight gain than conventional antipsychotics (see, forexample, Bustilllo, 1996). Weight gain was found to be greatest withclozapine, olanzapine, risperidone, and quetiapine, and less witharipiprazole and ziprasidone, and an additive effect on weight gain wasfound to occur in patients treated with antipsychotic medications andconcomitantly with a drug from another class which may cause weight gainthrough a different mechanism, such as valproate (Kane, 2003). Weightgain with clozapine and olanzapine was found to persist for up to 30weeks of treatment, and to be associated with a higher mean weight gainthan for risperidone, haloperidol and sertindole (Wirshing, 2004).Risperidone-treated patients were found to gain weight for an initial8-week period and then reach plateau level. Weight gain was also foundto be more problematic for children and adolescents than for adults.

The mechanisms by which antipsychotic drugs cause weight gain are notclear. Antipsychotic drugs have multiple effects on neurotransmittersystems, which in turn have a range of effects on energy homeostasis.Most of the antipsychotics work through some degree of dopamine blockade(Wirshing, 2004), but modulation of the serotogenic, histaminergic, andadrenergic systems, all of which have potential impact on weightregulation, may also be involved. Most of the atypical antipsychoticswork through a combination of receptor systems. Olanzapine and clozapinehave the highest affinity for the H₁ receptor of all the atypicalantipsychotics, and are also associated with the highest weight gain. Alogarithmic relationship between H1 receptor affinity and weight gainhas been demonstrated (Wirshing, 1999). In addition, many atypicalantipsychotics exhibit activity at several serotonin receptor subtypes,including the 5-HT_(2C) subtype, which appears to mediate some effectson appetite. Olanzapine and clozapine both have high affinities for5-HT_(2A), 5-HT_(2C), H₁-histaminergic, and M₁-muscarinic receptors.Clozapine also has high affinity for α₁-adrenergic receptors.Ziprasidone, which is associated with minimal weight gain, has moreserotogenic and less adrenergic, histaminic and muscarinic receptoraffinity. Quetiapine has relatively high affinity for histaminereceptors; risperidone has modest H₁ affinity, but notable affinity for5-HT_(2A) and 5-HT_(2C) receptors. There are also endocrine effects ofatypical antipsychotics, which presumably also play a role in weightgain.

A dual effect of the atypical antipsychotics in weight gain has beenproposed: one, appetite stimulation by a direct effect on the brain,that may be observable in the short term; and second, a delayedendocrine/metabolic dysfunction that promotes fat deposition (Baptista,2004). Involvement of the cytokine peptides leptin and tumor necrosisfactor (TNF)-α in anti-psychotic-induced weight gain has also beensuggested.

The use of atypical antipsychotics has also been found to place patientsat risk for various metabolic disorders, including metabolic syndrome,which results in weight gain, as well as in hypertriglyceridemia, and inincreased insulin, glucose, and low-density lipoprotein cholesterollevels (Lieberman, 2004). According to a recent review (Newcomer, 2005),clozapine and olanzapine treatment are associated with an increased riskof diabetes mellitus and dyslipidemia. A smaller effect is observed withrisperidone and quetiapine. In general, it appears from the rank orderof risk of diabetes and dyslipidemia observed for the atypicalantipsychotics, that the risk is related to the differing weight gainliabilities of the drugs. It is suggested that the increased incidenceof diabetes in patients receiving antipsychotics is not due purely toweight gain, since patients can develop diabetes without significantweight gain, and diabetes usually improves rapidly when theantipsychotic is withdrawn (Koller, 2001; Koller, 2002). The mechanismsleading to diabetes can include the drug induced weight gain, but thereis also evidence of a direct metabolic effect. This may be related toantagonism at the 5-HT₂ or histamine H₁ receptors or to an elevation ofserum leptin beyond that induced by increased body weight alone (Lean,2003).

Dyslipidemia is most often associated with clozapine and olanzapine, andis primarily seen as an increase in triglyceride levels, but may alsomanifest as increased total cholesterol, LDL-cholesterol and decreasedHDL-cholesterol (Barrett, 2004).

The use of atypical antipsychotics have also been associated with anincrease in eating disorders, such as binge eating disorder, and bulimianervosa (Theisen, 2003), which may be a secondary effect of the weightgain associated with these medicaments, resulting in reduced self esteemand repeated unsuccessful dietary trials.

Weight gain commonly occurs also as a result of cessation of smoking.This may be due to the fact that smoking burns calories, artificiallyelevates heart rate and increases metabolism. Upon cessation of smoking,the subject has to readjust to a lower metabolic rate.

Furthermore, nicotine is an appetite suppressant. Nicotine stimulatesrelease of adrenaline, which acts upon the liver to step-up thebreakdown of glycogen so that more glucose will be liberated into theblood. Nicotine also affects release of insulin, which controls glucoselevels in the blood. Hence, nicotine causes slight hyperglycemia, and asa result, the body and brain may slow down the hormones and othersignals that trigger feelings of hunger.

In addition, a subject suffering from nicotine withdrawal may turn tofood for emotional comfort. Also, since smoking dulls the taste buds,food begins to taste better to new non-smokers, which can lead toincreased food intake. Weight gain may also be caused by drugsprescribed to assist in smoking cessation. Anti-smoking medicationsinclude Zyban™ (bupropion hydrochloride).

Weight gain frequently also occurs during a holiday season, when thesubject may have more opportunity to over-indulge in food, due toincreased leisure time, increased availability of food, reduced exerciseetc., or due to increased participation in meals in a social context.Such weight gain is greater during holidays, such as religious ornational holidays, which are associated with consumption of specificfoods or festive meals. Examples of such holidays include Thanksgiving,Christmas, and Passover.

There are several different treatment options for management of weight,including: dietary therapy, physical activity, behavior therapy, drugtherapy and surgery. For the majority of overweight and obese people,who find they are unable to change their lifestyle, drug therapy is themost favorable and applicable option. Although hundreds of millions ofpeople are seeking drug therapy for the treatment of obesity, currentdrug therapies do not meet this need due to their undesired side effectsand limited efficacy.

Medications for the treatment of obesity are currently approved for usein adults with a body-mass index of 30 or higher, or with a body-massindex of 27 or higher who have obesity-related medical problems(Physicians' Desk Reference, 2001). Approximately 10 percents of womenand 3 percents of men with a body-mass index of 30 or higher reportedlyuse weight-loss medications (Serdula, 1999).

Medications currently approved for weight loss in the United States fallinto two categories: those that decrease food intake by reducingappetite or increasing satiety (appetite suppressants), and those thatdecrease nutrient absorption. A potentially third category, medicationsincreasing energy expenditure, such as ephedrine, is not currentlyapproved for treating obesity in the United States.

The only FDA-approved medication for obesity that reduces nutrientabsorption is orlistat (Xenical™), which acts by binding togastrointestinal lipases in the lumen of the gut, preventing hydrolysisof dietary fat into absorbable free fatty acids and monoacylglycerols.

Most appetite suppressants work primarily by increasing the availabilityof anorexigenic neurotransmitters—notably norepinephrine, serotonin,dopamine, or some combination of these neurotransmitters—in the centralnervous system. Noradrenergic drugs available in the United Statesinclude phentermine, diethylpropion, phendimetrazine, and benzphetamine.Some of these drugs are considered by the Drug EnforcementAdministration (DEA) to have a potential for abuse. Amphetamines, whichare considered to have a particularly high potential for abuse are nolonger recommended for weight loss for this reason. The Food and DrugAdministration (FDA) approves the medications for use of “a few weeks”only (generally presumed to be 12 weeks or less) for the treatment ofobesity.

Side effects of noradrenergic medications include insomnia, dry mouth,constipation, euphoria, palpitations, and hypertension (Physicians' DeskReference, 2001).

Serotonergic agents act by increasing the release of serotonin,inhibiting its reuptake, or both. Fenfluramine (Pondimin™) anddexfenfluramine (Redux™), medications that both stimulate serotoninrelease and inhibit its reuptake, were withdrawn from the market in theUnited States in 1997 because of associations with valvular heartdisease and pulmonary hypertension. Some selective serotonin-reuptakeinhibitors have induced weight loss in short-term studies, andfluoxetine (Prozac) has undergone considerable evaluation to determineits efficacy for weight loss (Goldstein, 1993). However, after initialweight loss, steady regain was observed in later stages of the treatment(National Task Force on the Prevention and Treatment of Obesity).Sertraline (Zoloft™), evaluated as an adjunct for weight maintenanceafter a very-low-calorie diet, showed a similar lack of long-termefficacy (Wadden, 1995). Sibutramine (Meridia™, Reductil™), an inhibitorof both norepinephrine reuptake and serotonin reuptake that also weaklyinhibits dopamine reuptake, is approved by the FDA for weight loss andweight maintenance in conjunction with a reduction diet. Side effects ofsibutramine include increased blood pressure and pulse frequency rate(McMahon, 2000).

Rimonabant (Sanofi), which is claimed to stop food cravings, representsa new class of drugs that inhibit the activity of the CB1 receptor. TheCB1 receptor forms a part of the endocannabinoid system. The CB1receptor has been found in the brain, fat cells and other parts of thebody, and has been associated with regulating food intake and withtobacco dependency (Pi-Sunyer et al., 2004). The endocannabiniod systemhelps to regulate pleasure, relaxation, and pain tolerance. Little iscurrently known about the long-term effects of inhibition of thissystem. Further, neurologists point out that the endocannabinoid systemhelps to protect the brain under some circumstances (such as stroke andhead injury,) such that brain damage in these circumstances might beworse in patients taking drugs that block the endocannabiniod system.

The Rimonabant drug is currently undergoing phase III clinical trials.Presently reported side effects associated therewith include anxiety,nausea and diarrhea.

Hence, although some of the currently approved medications show moderateeffects and can help some patients in losing weight, there is acontinuing need for efficacious treatment regimes and drugs foralleviating the serious and prevalent disorder—the weight excess.

Histamine, a potent bioactive substance that has been studied for nearlya century, is an aminergic neurotransmitter. Four histamine receptorshave been identified: H₁, H₂, H₃, and H₄, leading to the discovery andtherapeutic use of potent receptor antagonists. Activation of the H₁receptor is associated with effects on smooth muscle and centralneurons; activation of the H₂ receptor stimulates acid secretion in thestomach, while activation of the H₃ receptor results in a pre-synapticautoregulatory effect.

Histamine has been implicated, among others, in the regulation ofarousal state (Lin et al., 1990), locomotor activity (Clapham, 1994),cardiovascular control (Imamura, 1996), water intake (Lecklin, 1998),food intake (Leurs, 1998), and memory formation (Blandina, 1996). It hasbeen suggested that histaminergic neural circuits arising in thetuberomammilary nucleus and projecting into the satiety centers of thehypothalamus participate in regulation of food intake. Histaminergicneurons project into hypothalamic centers known to participate in foodintake i.e. the paraventricular nucleus and ventromedial hypothalamus,where the anorectic effect is thought to be mediated by postsynaptichistamine H₁ receptors. The density of this receptor, together with theH₃-receptor-mediated control of the intrasynaptic concentration ofhistamine, both seem to be crucial for the strength of the anorecticsignal. Some studies have indicated that histamine may suppress appetiteby acting on hypothalamic histaminergic neurons that participate in theregulation of food intake (Sakata, 1997; Bjenning, 2000; Sakata, 1995).Thus, it was reported that histamine injected intracerebroventricularlyacts as an appetite suppressant, and that depletion of histaminestimulates feeding (Tuomisto, 1994). Changes in histaminergic tone inthe CNS have been associated with genetic models of obesity (Machidori,1992). In addition, intracerebroventricular injection of leptin has beencorrelated with changes in the turnover rate of hypothalamic neuronalhistamine (Yoshimatsu, 1999). Since histamine is unable to cross theblood brain barrier, these effects would not be expected to be seen withsystemic administration of histamine.

In both humans and rodents, treatment with an H₁ antagonist resulted inhyperphagia (Fukagawa, 1989), and administration of H₃ antagonists ledto hypophagia (Attoub, 2001). The selective histamine H₃ receptorantagonist NNC 38-109 has been reported to increase hypothalamichistamine levels, in parallel with decreases in food intake and bodyweight, according to studies in intact HEK293 cells expressing human orrat histamine H₃ receptors (Malmof, 2005). The intrasynapticconcentration of histamine is primarily controlled by feedback signalsfrom presynaptic histamine H₃ receptors that inhibit both the conversionof L-histadine to histamine and the release of histamine into thesynaptic clefts. Thus, by reducing the inhibition using a selectivehistamine H₃ receptor antagonist, the synaptic concentration ofhistamine increases together with the signaling from the histamine H1receptor, and food intake is consequently inhibited. However, thelong-term effects of H₃ receptors on anorexigenic activities forbody-weight homeostasis have not been documented because of theoff-target activity (Leurs, 1995) and toxicity profile of H₃ inhibitors(Onderwater, 1998).

Betahistine (also known by its chemical names2-[2-(methylamino)ethyl]pyridine and N-methyl-2-pyridineethaneamine) isan orally active histamine-like drug extensively used in the symptomatictreatment of vestibular disorders, mainly Menier's disease and vertigo(including vertigo in patients with migraine (Amelin, 2003), dizzinesswith recurrent vertigo (Acta Otolaryngol., 2003), vertigo in patientswith vascular and traumatic cerebral injuries (Gusev, 1998), and benignparoxysmal positional vertigo (Fujino, 1994)). Studies have shown thatbetahistine can be further utilized in the treatment of a variety ofdisorders, including the after-effects of craniocerebral injury andvascular events (Odinak, 2005), preventing or reducing myocardialinfraction after occurrence of coronary occlusion (U.S. Pat. No.4,159,332), multiple sclerosis (Boika, 2002), cutaneous hypersensitivityin patients with grass pollen allergy (Synman, 1995), arterioscleroticdementia (Seipel, 1977), acute deafness (Grahne, 1976),vertebral-basilar insufficiency (Botez, 1975), and seasickness (J.Vestib. Res. 2003).

Betahistine is a structural analog of histamine, in which the imidazolering of the histamine is replaced by a pyridine ring. Betahistine is anH₁ receptor agonist, and has been found to exhibit an H₁-agonismactivity of about 0.07 times that of histamine, and to cause hypotensiveresponse, bronchoconstriction, and increased vasopermeability afterparenteral administration. Receptor binding studies have also shown thatbetahistine is a potent H₃-receptor antagonist. Betahistine is able tocross the blood brain barrier and act centrally by enhancing histaminesynthesis is tuberomammillary nuclei of the posterior hypothalamus.Adverse side effected associated with betahistine are typically minorand include skin rashes of various types, urticaria, and itching.Gastric upset, nausea, and headache have also been reported by somepatients.

It has been found (Rossi et al., 1999) that high doses of betahistine,delivered intraperitoneally, increased water intake and decreased foodintake in pygmy goats. This was suggested as being due to stimulation ofboth H₁ and H₂ receptors, since in addition to its known action as an H₁receptor agonist, betahistine has been shown to act as a weak partialagonist of peripheral histamine H₂ receptors (Arrang et al., 1985). Thisidea is further supported by recent findings showing that the hypophagiceffect of histamine was blocked by the H₂-receptor antagonist,cimetidine, in pygmy goats. These similarities in the hypophagic effectsof histamine and betahistine suggest an involvement of H₂-receptors inthe hypophagic effect of betahistine in pygmy goats. H₂-receptors arenot, however, associated with weight change in humans (Rasmussen, 1993).

Szelag et al. (2001) found that betahistine, when givenintraperitoneally, decreased food intake in rats, whereas this effectwas not seen when betahistine was given intragastrically (Szelag, 2002).It was suggested that the effect of betahistine administration on foodintake involves increasing histamine synthesis and release as a resultof H₃ receptor inhibition. However, since activation of H₂ receptors isknown to stimulate hydrochloric acid secretion (see, for example,Clayman, 1977), it was further suggested that the lack of the influenceof betahistine on food intake after intragastrical administration may bedue to the fact that betahistine increased hydrochloric acid release byactivation of H₂ receptors, thereby abolishing the central anorecticactivity of betahistine.

It was also suggested that the effects on H₁ receptors in humans maydiffer significantly from those in rats due to variations in circadianrhythm between the species. Therefore, it appears that the artorecticresponse of betahistine is dependent upon species and route ofadministration. Nevertheless, Szelag et al. fail to teach the effect ofbetahistine administered orally or by any other route of administration,on food intake in humans.

Lecklin et al. (2002) found that inhibition of histamine catabolism byintraperitoneal injection of metoprine, a histamine-N-methyltransferaseinhibitor, resulted in suppressed daily energy intake and ingestion offat in rats.

Pharmacokinetic studies showed that betahistine is transformed, mainlyin the liver, to 2-(2-aminoethyl)-pyridine (AEP) and to2-(2-hydroxyethyl)-pyridine (HEP), (Sternoson, 1974) whereas bothbetahistine and the metabolites bind to histamine receptors.

The cited references corroborate the complexity of appetite regulation,which includes, among other factors, species specificity and route ofadministration. It has further been found (Seifert et al., 2003) thatmultiple differences exist in agonist and antagonist pharmacology ofhistamine receptors between different species, such as humans and guineapigs. The prior art does not teach or suggest the use of H₁ agonists forregulating food intake in humans. The prior art further does not teachor suggest the use of such H₁ agonists that have a pharmacological halflife that permits an efficient treatment therewith. The prior artfurther does not teach or suggest the use of orally administered H₁agonists for regulating food intake in humans.

There is thus a widely recognized need for and it would be highlyadvantageous to have histamine-related agents for regulation of foodintake in humans and for reducing weight gain associated with e.g., drugtreatment, devoid of the above limitations.

SUMMARY OF THE INVENTION

The present invention successfully addresses the shortcomings of thepresently known methods for regulating food intake by providing suchmethods that utilize H₁ receptor agonists, which are highly efficient inhumans, which have a pharmacological half life of at least 3 hours andwhich are devoid of the limitations of the currently known methods. Thepresent invention further provides methods for preventing or reducingweight gain associated with external factors such as drug treatment,smoking cessation and the like.

According to one aspect of the present invention there is provided amethod of treating a condition in which regulating a food intake in ahuman subject is beneficial, the method comprising administering to thesubject a therapeutically effective amount of an H₁ agonist, which has apharmacological half-life of at least 3 hours.

According to further features in preferred embodiments of the inventiondescribed below, the condition is selected from the group consisting ofovereating, overweight, obesity, and a disorder caused or exacerbatedthereby. The condition caused or exacerbated by the conditions accordingto this aspect of the present invention may be selected from the groupconsisting of a muscosceletal disorder, a cardiovascular disorder, adermatological disorder, a sleep disorder, a metabolic condition,diabetes and a diabetes-related condition.

According to still further features in the described preferredembodiments, the condition is associated with high fat consumption.

According to still further features in the described preferredembodiments, the condition is associated with a psychological factor.The condition according to this aspect of the present inventionoptionally comprises binge eating disorder, night eating syndrome,obsessive eating, compulsive eating or bulimia.

According to still further features in the described preferredembodiments the condition is associated with a drug treatment. The drugmay optionally consist of a steroid hormone or a psychoactive drug, asis detailed hereinbelow.

According to another aspect of the present invention, there is provideda method of improving a compliance of a human subject to caloricrestriction, the method comprising administering to the subject atherapeutically effective amount of an H₁ agonist, which has a half-lifeof at least 3 hours.

According to still another aspect of the present invention, there isprovided a method of reducing a desire of a human subject to consumefats, the method comprising administering to the subject atherapeutically effective amount of an H₁ agonist, which has a half-lifeof at least 3 hours.

According to yet another aspect of the present invention, there isprovided a method of treating a condition associated with a metabolicderangement in a human subject, the method comprising administering tothe subject a therapeutically effective amount of an H₁ agonist whichhas a half-life of at least 3 hours. The metabolic derangement may be,for example, dyslipidemia, such as hypercholesterolemia or lipemia.

As used herein, the term “metabolic derangement” refers to an imbalancein the level of one or more metabolites within a body. A commonmetabolic derangement is typically associated with an imbalance in thelevel of metabolites such as cholesterol, including LDL and HDL,triglycerides and the like.

According to still another aspect of the present invention, there isprovided a method of reducing total cholesterol level in a humansubject, the method comprising administering to the subject atherapeutically effective amount of an H₁ agonist which has a half-lifeof at least 3 hours.

According to still another aspect of the present invention, there isprovided a method of reducing low-density lipoprotein (LDL) cholesterolor increasing high-density lipoprotein (HDL) cholesterol levels in ahuman subject, the method comprising administering to the subject atherapeutically effective amount of an H₁ agonist which has a half-lifeof at least 3 hours.

According to still another aspect of the present invention, there isprovided a method of reducing triglyceride level in a human subject, themethod comprising administering to the subject a therapeuticallyeffective amount of an H₁ agonist which has a pharmacological half-lifeof at least 3 hours.

According to yet another aspect of the present invention there isprovided a method of treating an eating disorder, the method comprisingadministering to the subject a therapeutically effective amount of an H₁agonist, said H₁ agonist having a pharmacological half-life of at least3 hours.

The eating disorder can be, for example, bulimia and binge eatingdisorder.

According to a further aspect of the present invention there is provideda method of preventing weight gain or reducing weight in a subject, themethod comprising administering to the subject a therapeuticallyeffective amount of an H₁ agonist, said H₁ agonist having apharmacological half-life of at least 3 hours.

According to further features in preferred embodiments of the inventiondescribed below, weight gain prevented or reduced by the method of thepresent invention may be associated with a drug treatment.

The drug may be, for example, an antipsychotic. Examples of suchantipsychotics include, without limitation, selective serotonin-reuptakeinhibitors (such as fluvoxamine, escitalopram, citalopram, andparoxetine); monoamine oxidase inhibitors (such as isocarboxazid,phenelzine and tranylcypromine); conventional antipsychotics (such ashaloperidol, molindone and thioridazine); and atypical antipsychotics(such as clozapine, olanzapine, risperidone, quetiapine, sertindole,aripiprazole and ziprasidone, or an antagonist of a 5-HT_(2A),5-HT_(2C), H₁-histaminergic or M₁-muscarinic receptor).

Alternatively, the drug may be an antidepressant. Examples of suchantidepressants include, without limitation, a tricyclic antidepressant(such as amitryptyline, amoxapine, clomipramine, desipramine, doxepin,imipramine, nortryptyline, protriptyline or trimipramine), a tetracyclicantidepressant (such as mirtazapine or maprotiline), aserotonin-norepinephrine reuptake inhibitor (such as venlafaxine orduloxetine); and additional antidepressants such as biproprionhydrochloride, mitrazapine, nefazadone and trazadone.

Also alternatively, the drug may be a mood-stabilizer (such as lithium);a calcium channel blocker (such as diltiazern, nicardipine, verapamiland nimopidipine); an anti-convulsant (such as carbamazepine-,divalproex, lamotrigine, sodium valproate, valproic acid, andgabapentin); a proton pump inhibitor (such as omeprazole, esomeprazole,lansoprazole and pantoprazole); an antidiabetic agent (such as asulfonylurea, including chlorpropamide, glipizide, glyburide, andglimepiride, a meglitinide, a biguanide, a thiazolidinedione, analpha-glucosidase inhibitor, and insulin); an antihypertensive (such asan alpha-adrenergic blocker, including doxazocin, prazocin andterazosin; or a beta blocker, including acebutolol, atenolol,metoprolol, nadolol, pindolol and propanolol); or an anti-smokingmedication.

Further alternatively, the drug may be a hormone, such as, for example,a steroid hormone. Non-limiting examples of such steroid hormonesinclude a corticosteroid (such as a glucocorticoid, including prednisoneand cortisol; and a mineralocorticoid, including aldosterone andfludrocortisone); and a sex steroid (such as an androgen, includingtestosterone and dehydroepiandrosterone; an estrogen, such as estradiol;and a progestagen, such as progesterone or progestin), or mixturesthereof. Thus, for example the sex steroid may comprise estrogen andprogestagen, such as provided as an oral contraceptive formulation; orestrogen and progestin, such as used for hormone replacement therapy.

According to yet further features in preferred embodiments of theinvention, weight gain prevented or reduced by the method of the presentinvention may be due to cessation of smoking.

According to still further features in preferred embodiments of theinvention described below, weight gain prevented or reduced by themethod of the present invention may occur during a holiday season.

According to further features in the described preferred embodiments,the pharmacological half-life of the H₁ agonist ranges from about 3hours to about 12 hours, preferably from about 3 hours to about 8 hours,more preferably from about 3 hours to about 5 hours.

According to still further features in the described preferredembodiments, the H₁ agonist is further an H₃ antagonist.

According to still further features in the described preferredembodiments, the H₁ agonist is characterized by blood brain barrierpermeability.

According to still further features in the described preferredembodiments, the H₁ agonist is selected from the group consisting ofbetahistine, a betahistine metabolite, a betahistine pharmaceuticallyacceptable salt, a betahistine prodrug, a betahistine derivative and anycombination thereof. Preferably, the betahistine metabolite is2-(2-aminoethyl)-pyridine or 2-(2-hydroxyethyl)-pyridine. Alsopreferably, the betahistine salt is betahistine dihydrochloride,betahistine mesilate, or betahistine trimebutine maleate. Alsopreferably, the betahistine derivative is selected from the group ofcompounds represented by the general formula I:

wherein each of R₁-R₁₂ is independently selected from the groupconsisting of hydrogen, alkyl, cycloalkyl and aryl.

According to still further features in the described preferredembodiments, in each of the methods described herein, administering iseffected by a route selected from the group consisting of the oral,transdermal, intravenous, subcutaneous, intramuscular, intranasal,intraauricular, sublingual, rectal, transmucosal, intestinal, buccal,intramedullar, intrathecal, direct intraventricular, intraperitoneal,and intraocular routes. Preferably, administering is effected by theoral, transdermal, buccal, transmucosal, rectal or sublingual routes.More preferably, administering is effected by the oral, buccal ortransdermal routes.

According to still further features in the described preferredembodiments, the therapeutically effective amount ranges from about 2 mgper day to about 96 mg per say, preferably from about 10 mg per day loabout 50 mg per day.

According to still further features in the described preferredembodiments, administering is effected from about 1 to about 4 times perday, preferably, twice per day.

According to still further features in the described preferredembodiments, administering is effected according to the development ofhunger of the subject.

According to still further features in the described preferredembodiments, administering is performed such that a decrease of the bodyweight of the subject that ranges from about 1 to about 5 percent iseffected, without restricting the food intake of the subject.Preferably, such administering is performed such that no down-regulationof H₁ receptors is effected.

As used herein, the term “down-regulation” with regard to receptorsrefers to a decrease in the responsiveness of the receptor, or to adecrease in the number or density of receptors. Decreasing theresponsiveness of a receptor also includes a complete shutdown of thereceptor.

According to still further features in the described preferredembodiments, the H₁ agonist forms a part of a pharmaceuticalcomposition, which further comprises a pharmaceutically acceptablecarrier. Such a composition may optionally provide a slow releasecomposition.

As used herein a “pharmaceutical composition” refers to a preparation ofone or more of the active ingredients described herein, either compoundsor physiologically acceptable salts thereof, with other chemicalcomponents such as traditional drugs, physiologically suitable carriersand excipients. Thus, pharmaceutical compositions, according to thepresent invention, can include, for example, the H₁ agonist describedherein and an additional active ingredient, as is detailed herein.

For example, pharmaceutical compositions, according to the presentinvention, can include a therapeutically effective amount of the H₁agonist described herein and a therapeutically effective amount of adrug associated with weight gain, as is detailed herein.

Such compositions can be used to treat a medical condition is whichtreatment with the drug is beneficial, as detailed herein, whilereducing or preventing weight gain associated with the drug treatment,as discussed in detail hereinbelow.

Pharmaceutical compositions, according to the present invention, caninclude, for example, a therapeutically effective amount of the H₁agonist described herein and a therapeutically effective amount of anagent for treating a metabolic derangement, as is detailed herein.

Such pharmaceutical compositions can be used in the treatment ofconditions associated with high fat consumption, such as dyslipidemia,and hypercholesterolemia, for reducing total cholesterol level in ahuman subject, for reducing low-density lipoprotein cholesterol andincreasing high-density lipoprotein cholesterol levels in a humansubject and/or for reducing triglyceride level in a human subject.

According to still further features in the described preferredembodiments, each of the methods described herein further comprisesadministering to the subject a therapeutically effective amount of anadditional active agent such as, for example, a weight control agent.The weight control agent may be, for example, an appetite suppressant.Representative examples of suitable appetite suppressants include,without limitation, noradrenergic agents, serotonergic agents,dopamingergic agents, endocannabinoid receptor blockers, or combinationsthereof.

According to still further features in the described preferredembodiments, the additional active agent may be a non-steroidalanti-inflammatory drug, a muscle relaxant, an antigout agent, animmunosuppressant, a drug affecting bone mineralization, anangiotensin-converting enzyme inhibitor, an antiarrhythmic drug, ananticoagulant, an antiplatelet, a thrombolytic, a beta-adrenergicblocking drug, a centrally acting drug, a digitalis drug, a nitrate, aperipheral adrenergic antagonist, a vasodilator, an acne medication, anantipruretic agent, an anti-psoriasis agent, an anti-eczema agent, ahypnotic, an anti-histamine, a PPAR-gamma antagonist, insulin, afibrate, an HMG-CoA reductase inhibitor, a bile acid sequestrant, acholesterol absorption inhibitor, nicotinic acid, a derivative, analogand metabolite thereof, and any mixture thereof.

According to still further features in the described preferredembodiments, the additional active agent may be a nutritionalsupplement. An example of such a nutritional supplement is Histidine(Kasaoka S. Nutrition 20:991-996(2004).

According to still further features in the described preferredembodiments, the methods described herein are used for inducing weightloss. Alternatively, these methods are used for maintaining weight lossor preventing a weight gain after or during a weight reducing diet.Further alternatively, these methods are used for preventing weight gainin a subject having a condition associated with weight gain.

In each of the methods described herein, the H₁ agonist is preferablynot used for treating patients also having a medical condition that haspreviously been described as treatable by such an agonist.

Thus, in each of the various aspects of the present invention, thesubjects treated by any of the methods described herein are preferablysubjects that do not also suffer from a condition that has already beendescribed in the art as treatable by the H₁ agonist described herein.Such conditions include, for example, Menier's disease, vertigo,seasickness, the after-effects of craniocerebral injury and vascularevents, myocardial infraction after occurrence of coronary occlusion,multiple sclerosis, cutaneous hypersensitivity in patients with grasspollen allergy, arteriosclerotic dementia, acute deafness, andvertebral-basilar insufficiency.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the present invention, suitable methods andmaterials are described below. In case of conflict, the patentspecification, including definitions, will control. In addition, thematerials, methods, and examples are illustrative only and not intendedto be limiting.

As used herein the term “method” refers to manners, means, techniquesand procedures for accomplishing a given task including, but not limitedto, those manners, means, techniques and procedures either known to, orreadily developed from known manners, means, techniques and proceduresby practitioners of the chemical, pharmacological, biological,biochemical and medical arts.

As used herein, the term “treating” includes abrogating, substantiallyinhibiting, slowing or reversing the progression of a condition,substantially ameliorating clinical or aesthetical symptoms of acondition or substantially preventing the appearance of clinical oraesthetical symptoms of a condition.

As used herein, the term “preventing” includes barring an organism fromacquiring a condition in the first place.

As used herein the term “regulating” with regard to food intake refersto controlling or adjusting the food intake to a desired level.

The term “comprising” means that other steps and ingredients that do notaffect the final result can be added. This term encompasses the terms“consisting of” and “consisting essentially of”.

The phrase “consisting essentially of” means that the composition ormethod may include additional ingredients and/or steps, but only if theadditional ingredients and/or steps do not materially alter the basicand novel characteristics of the claimed composition or method.

The term “therapeutically effective amount” or “pharmaceuticallyeffective amount” denotes that dose of an active ingredient or acomposition comprising the active ingredient that will provide thetherapeutic effect for which the active ingredient is indicated.

As used herein, the term “agonist” describes a substance that is capableof binding to a receptor on a cell and thereby initiating aphysiological activity or pathway. The phrases “H₁-receptor agonist” and“H₁ agonist” are used herein interchangeably.

As used herein, the term “antagonist” describes a substance that actswithin the body to reduce the physiological activity of anothersubstance.

As used herein, the phrase “pharmacological half-life” describes thetime required for half the quantity of a drug or other substancedeposited in a living organism to be metabolized or eliminated from theplasma by normal biological processes. This phrase is also referred toherein interchangeable as “half life”.

As used herein, the term “pharmaceutically acceptable” means approved bya regulatory agency of the Federal or a state government or listed inthe U.S. Pharmacopeia or other generally recognized pharmacopeia for usein animals, and more particularly in humans. Herein, the phrases“physiologically suitable carrier” and “pharmaceutically acceptablecarrier” are interchangeably used and refer to an approved carrier or adiluent that does not cause significant irritation to an organism anddoes not abrogate the biological activity and properties of theadministered conjugate.

As used herein, the term “carrier” refers to a diluent, adjuvant,excipient, or vehicle with which the therapeutic is administered.

Herein the term “excipient” refers to an inert substance added to apharmaceutical composition to further facilitate processes andadministration of the active ingredients.

As used herein, the singular form “a,” “an,” and “the” include pluralreferences unless the context clearly dictates otherwise. For example,the term “a compound” or “at least one compound” may include a pluralityof compounds, including mixtures thereof.

Throughout this disclosure, various aspects of this invention can bepresented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of theinvention. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible subranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 3, 4, 5, and 6. This appliesregardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to includeany cited numeral (fractional or integral) within the indicated range.The phrases “ranging/ranges between” a first indicate number and asecond indicate number and “ranging/ranges from” a first indicate number“to” a second indicate number are used herein interchangeably and aremeant to include the first and second indicated numbers and all thefractional and integral numerals therebetween.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin the cause of providing what is believed to be the most useful andreadily understood description of the principles and conceptual aspectsof the invention. In this regard, no attempt is made to show structuraldetails of the invention in more detail than is necessary for afundamental understanding of the invention, the description taken withthe drawings making apparent to those skilled in the art how the severalforms of the invention may be embodied in practice.

In the drawings:

FIGS. 1(a-b) present results obtained in prior art studies,demonstrating the effect of Metoprine treatment on the total caloricintake (FIG. 1 a) and the fat intake (FIG. 1 b) in rats;

FIGS. 2(a-b) present results obtained in prior art studies,demonstrating the effect of Metoprine treatment on the total caloricintake, compared with the carbohydrate intake (FIG. 2 a) and the proteinintake (FIG. 1 b) in rats;

FIG. 3 presents plots demonstrating the effect of overweight (expressedas the body mask index) on the relative risk of death fromcardiovascular disease (dotted line), cancer (dashed line) and othercauses in men (upper plots) and women (bottom plots);

FIG. 4 is a bar graph presenting the effect of oral administration ofbetahistine (blue bars) and a placebo (yellow bars) on the total caloricintake of humans following 14 days and 28 days of treatment;

FIG. 5 is a bar graph presenting the effect of oral administration ofbetahistine (blue bars) and a placebo (yellow bars) on the fat,carbohydrate and protein intake of humans following 14 days and 28 daysof treatment; and

FIG. 6 is a bar graph presenting the effect of oral administration ofbetahistine (blue bars) and a placebo (yellow bars) on the weight changein humans following 14 days and 28 days of treatment.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is of novel methods for regulating food intake ina human subject; for improving a compliance of a human subject tocaloric restriction; and for reducing a desire of a human subject toconsume fats, all of which utilize H₁-receptor agonists that have apharmacological half-life that allows an efficient treatment regimethereof. The present invention further provides a method for preventingor reducing weight gain in a human subject, by administration ofH₁-receptor agonists that have a pharmacological half-life that allowsan efficient treatment regime thereof.

The principles and operation of the compositions and methods accordingto the present invention may be better understood with reference to thedrawings and accompanying descriptions.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not limited in its applicationto the details set forth in the following description or exemplified bythe Examples. The invention is capable of other embodiments or of beingpracticed or carried out in various ways. Also, it is to be understoodthat the phraseology and terminology employed herein is for the purposeof description and should not be regarded as limiting.

As is described hereinabove, many of the presently used appetitesuppressants are known to have a potential for abuse. Furthermore, theseappetite suppressants are associated with various side effects, rangingfrom insomnia, dry mouth, constipation, euphoria, palpitations andhypertension, to valvular heart disease and pulmonary hypertension. Inaddition, many of these agents have been found to show a lack oflong-term efficacy, with steady weight-gain occurring after initialweight loss.

As is further described hereinabove, studies have shown a relationshipbetween histamine and regulation of food intake. Thus, for example, asshown in FIG. 1, inhibition of histamine catabolism by the histamineN-methyltransferase inhibitor, metoprine, which is typically utilized asa cytotoxic, anti-cancer agent, has been shown to suppress total foodintake and ingestion of fat by rats (Lecklin et al., 2002). Treatmenthad no marked effect on intakes of carbohydrates or protein, as shown inFIG. 2, indicating that an increase in the brain histamine content mayreduce specifically “fat-appetite”, namely, the desire to specificallyingest fats, as opposed to other food types.

Systemic administration of histamine, however, is extremely inefficientin its centrally mediated anti-obesity action because exogenoushistamine poorly penetrates the blood brain barrier. Histamine hastherefore been administered as an appetite suppressant hitherto byintracerebroventicular injection. Similarly, systemic administration ofhistamine would be expected to have little affect on the desire of ahuman subject to consume fats.

Furthermore, histamine has a pharmacological half-life of only a fewminutes. Therefore, the duration of action of the drug is very short,and it would need to be administered frequently in order to build up andmaintain a high enough concentration in the blood to be therapeuticallyeffective. A drug having a longer half life would therefore require lessfrequent administration, which may lead to increased patient compliancewith the dosing regime. This may also result in fewer side effects, aspeaks and troughs of the level of the drug in the bloodstream of thepatient may be decreased, leading to a more even drug level in the bloodover a period of time.

While several studies have suggested a role for H₁-receptor agonistsother than histamine in regulating food intake, none of these studieshas established a direct effect of such agonists on food intake inhumans.

The present inventors have now surprisingly found that certainH₁-agonists, which are characterized by relatively long half-life,particularly as compared with histamine, can be efficiently utilized forregulating food intake in humans. More specifically, it was found thatbetahistine, a presently known and approved drug for treating Menier'sdisease and associated conditions, and which has a half-life of about3.5 hours, efficiently affects food intake and caloric intake andreduces weight, as well as fat consumption, in obese female subjects. Asis exemplified in the Examples section that follows, in a randomizedplacebo controlled double-blinded study, it was found that betahistinehydrochloride decreased appetite, increase satiety lowered food intakeand particularly affected fat consumption.

It is therefore demonstrated herein that the administration of an H₁receptor agonist that has a pharmacological half life that permitsreasonable and efficient treatment therewith (e.g., of at least 3 hour)can be beneficially used for regulating food intake and caloric intakein a human subject and hence for treating medical and psychologicalconditions associated with overweight. Without being bound to anyparticular theory, it is assumed that betahistine, as well as other H₁receptor agonists, decrease food intake by a different mode of actionthan the currently used anti-obesity medications.

Thus, according to one aspect of the present invention there is provideda method of treating of a condition in which regulating a food intake ina human subject is beneficial, which is effected by administering to thesubject a therapeutically effective amount of an H₁ agonist that has apharmacological half-life of at least 3 hours.

It should be noted that as used herein the term “treatment” alsoincludes amelioration or alleviation of a pathological condition and/orone or more symptoms thereof, curing such a condition, or preventing thegenesis of such a condition.

The pharmacological half-life of the H₁ agonist utilized in this andother aspects of the present invention preferably ranges from about 3hours to about 12 hours, more preferably from about 3 hours to about 8hours, and even more preferably from about 3 hours to about 5 hours.Such a pharmacological half life is highly advantageous since, as isdiscussed hereinabove, such a drug remains in the blood for longerperiods than, for example, histamine, achieving steadier blood levels,and therefore fewer side effects. The H₁ agonist of the presentinvention therefore needs to be administered far less frequently than,for example, histamine, which has a half life of only about 2 minutes.Since, is is known in the art, 97% of a drug is eliminated after 5 halflives, the administration should be repeated at intervals of less than 5half lives, and usually less, depending on various parameters, includingthe clearance rate and the initial concentration administered.

In clinical practice, the choice of the dosage interval usuallyrepresents a compromise between the desirability of minimizing thevariations of effectiveness between doses and patient inconvenience fromtoo frequent dosing, which results in poor compliance. Dosage regimes ofone or two administrations per day are considered optimal.

Using a drug having a half life within the above cited range allows forselecting the administration times so as to ensure maximal effectivenessof the drug at times of day when the effect is most required, such as atknown meal times, periods of the day at which the subject most commonlyexperiences significant levels of hunger, etc., and to be leasteffective at times of (lay when no effect is necessary, such as, forexample, during periods when the subject is expected to be asleep.

Drugs having a very long half life have the disadvantage that once ortwice daily administration is clearly not possible. Less than dailyadministration is associated with poor patient compliance, as thesubject tends to forget the necessity to take a medication which is notpart of his daily routine. For example, thehistamine-N-methyltransferase inhibitor, metoprine, which, as discussedabove, has been shown to decrease food intake in rats, both byintraperitoneal injection and by central infusion, has a half life of216 hours. Furthermore, the issue of toxicity must be considered withdrugs having such long half lives.

In addition, it is known that a prolonged presence of H₁ agonists maylead to downregulation of the H₁ receptor.

Downregulation of a particular receptor after continuous activation canresult in decreased response to agonist administration, due to adaptivechanges in the receptors that limit their subsequent responsiveness, orto decrease in the number or density of receptors. Thesereceptor-specific changes include a rapid uncoupling of receptors fromactivation of their cognate G proteins, mediating functionaldesensitization; a rapid redistribution of receptors into relativelyinaccessible compartments in the plasma membrane or inside the cell,variously referred to as sequestration, endocytosis, or internalization;with prolonged agonist exposure, termed down-regulation. Considerableprogress has been made in recent years in identifying the receptormodifications involved in these changes (Krupnick et al., 1998),although many of the details of the molecular modifications andprotein-protein interactions that are involved in bringing about thesechanges remain to be determined. Down-regulation of a receptor type maylead to desensitization or tolerance to the agonist for the receptor. Itis therefore believed that use of an H₁ receptor agonist having ahalf-life of less than 12 hours, preferably less than 8 hours and morepreferably less than 5 hours prevents continuous exposure of thereceptor to the agonist, and thereby down-regulation of the receptor isavoided.

The H₁ agonist of the present invention is preferably also an H₃antagonist. H₃ antagonists have been shown to have an effect onregulation of food intake. It has been suggested that the inhibition ofH₃ receptor activity increases histamine release and synthesis.Histamine subsequently increases histaminergic neuron activity via H₁receptors and in this way inhibit food intake. H₃ receptors are locatednot only on histaminergic neurons, but also nonhistaminergic neurons asheteroreceptors, and modulate the release of 5-HT and noradrenaline.Thus, the effects of H₃ ligands on food intake may express through otherendogenous substances (Morimoto et al., 2001).

Also preferably, the H₁ agonist is characterized by blood brain barrierpermeability, and therefore is able to cross the blood brain barrier andenter brain tissue, thereby acting on central H₁ and H3 receptors. Thisenables the agonist to be administered by the systemic route, incontrast to, for example, histamine, which has very poor blood brainbarrier permeability and has therefore previously been administered asan appetite suppressant by intracerebroventicular injection.

The H₁ agonist of the present invention can be administered as anypharmaceutically acceptable salt, such as, for example, dihydrochloride,mesilate, or trimebutine maleate. Alternatively, the drug can beadministered as any metabolite, prodrug, or derivative, or combinationthereof.

The phrase “pharmaceutically acceptable salt” refers to a chargedspecies of the parent compound and its counter ion, which is typicallyused to modify the solubility characteristics of the parent compoundand/or to reduce any significant irritation to an organism by the parentcompound, while not abrogating the biological activity and properties ofthe administered compound.

The term “prodrug” refers to an agent, which is converted into theactive compound (the active parent drug) in vivo. Prodrugs are typicallyuseful for facilitating the administration of the parent drug. They may,for instance, be bioavailable by oral administration whereas the parentdrug is not. The prodrug may also have improved solubility as comparedwith the parent drug in pharmaceutical compositions.

As used herein, the term “metabolite” describes the actual active moietyof the compound which is formed as a result of metabolitic processesthat occur in vivo upon administration of the compound.

The term “derivative” describes the result of chemically altering,modifying or changing a compound or a portion thereof, such that itmaintains its original functionality in at least one respect.

According to a preferred embodiment of the present invention the H₁agonist is betahistine. Betahistine is a structural analog of histamine,which has been shown to have a binding affinity profile which isqualitatively close to that of histamine for both H₁ and H₃ receptors(Fossati et al., 2001). Furthermore, it is pharmacologically relevant,since pharmacokinetic data have shown that therapeutic dosages ofbetahistine in humans give plasma concentrations which fall in the samerange as its affinities for H₁ and H₃ receptors. The pharmacologicalrelevance of betahistine for H₁ receptors is further confirmed in vivoin animals and humans, attributable to the increased blood flow inmicrocirculation in the auditory and internal vestibular system (Meyeret al., 1974). Since betahistine has already been widely used fortreating vertigo and other disorders, it has been tested and is approvedfor use in human medicine.

Betahistine is readily absorbed through the oral route and is convertedto at least two metabolites, 2-(2-aminoethyl)-pyridine and2-(2-hydroxyethyl)-pyridine. Betahistine has an elimination half lifetime of 3.5 hours, and most of the dose is excreted via the urine asmetabolites. Hence, betahistine may be administered according to aconvenient dosage regime, as discussed above.

The side effects associated with betahistine are minor, consistingmainly of skin rashes of various types, urticaria, itching, gastricupset, nausea, headache, and exacerbation of symptoms in patients with ahistory of peptic ulcer.

Betahistine can be utilized in this and other aspects of the presentinvention either per se or as a metabolite, a pharmaceuticallyacceptable salt, a prodrug or a derivative thereof.

Betahistine metabolites that can be efficiently used in the context ofthe present invention include, for example, 2-(2-aminoethyl)-pyridineand 2-(2-hydroxyethyl)-pyridine. As is further described in the art(see, for example, Fossati et al., 2001) these metabolites are alsocharacterized by H₁-receptor agonist activity and therefore can also beutilized in the various aspects of the present invention.

Representative examples of betahistine pharmaceutically acceptable saltsthat can be efficiently used in the context of the present inventioninclude, without limitation, betahistine hydrochloride, betahistinedihydrochloride, betahistine mesilate, and betahistine trimebutinemaleate.

Betahistine derivatives that are suitable for use in the context of thisand other aspects of the present invention include, for example,compounds having the general Formula I:

In Formula I, each of R₁-R₁₂ is preferably independently selected fromthe group consisting of hydrogen, alkyl, cycloalkyl and aryl and anycombination thereof.

Optionally, each of R₁-R₁₂ can also be selected from other substituents,as long as features such as the blood brain barrier permeability, thehalf life and the binding to the H₁-receptor of the compound are notadversely affected. Thus, each of R₁-R₁₂ can be further independentlyselected, for example, from alkenyl, alkynyl, alkoxy, aryloxy, hydroxy,thiohydroxy, thioalkoxy, thioaryloxy, halide, amino, nitro, cyano,carbonyl, C-carboxy, O-carboxy, C-carmabyl, N-carbamyl, sulfonyl,sulfinyl, sulfonamide, urea, thiourea, guanidine, guanyl, O-carbamyl,N-carbamyl, O-thiocarbamyl, N-thiocarbamyl, C-amido, N-amido,N-sulfonamido, and S-sulfonamido or, alternatively, at least two ofR₁-R₄ and/or at least two of R₅-R₁₂ form at least one four-, five- orsix-membered aromatic, heteroaromatic, alicyclic or heteroalicyclicring.

It will be appreciated by one of skills in the art that the feasibilityof each of the substituents (R₁-R₁₂) to be located at the indicatedpositions depends on the valency and chemical compatibility of thesubstituent, the substituted position and other substituents. Hence, thepresent invention is aimed at encompassing all the feasible substituentsfor any position.

As used herein, the term “alkyl” refers to a saturated aliphatichydrocarbon including straight chain and branched chain groups.Preferably, the alkyl group has 1 to 20 carbon atoms. Whenever anumerical range; e.g., “1-20”, is stated herein, it implies that thegroup, in this case the alkyl group, may contain 1 carbon atom, 2 carbonatoms, 3 carbon atoms, etc., up to and including 20 carbon atoms. Morepreferably, the alkyl is a medium size alkyl having 1 to 10 carbonatoms. Most preferably, unless otherwise indicated, the alkyl is a loweralkyl having 1 to 4 carbon atoms. The alkyl group may be substituted orunsubstituted.

A “cycloalkyl” group refers to an all-carbon monocyclic or fused ring(i.e., rings which share an adjacent pair of carbon atoms) group whereinone of more of the rings does not have a completely conjugatedpi-electron system. Examples, without limitation, of cycloalkyl groupsare cyclopropane, cyclobutane, cyclopentane, cyclopentene, cyclohexane,cyclohexadiene, cycloheptane, cycloheptatriene, and adamantane. Acycloalkyl group may be substituted or unsubstituted.

An “alkenyl” group refers to an alkyl group which consists of at leasttwo carbon atoms and at least one carbon-carbon double bond.

An “alkynyl” group refers to an alkyl group which consists of at leasttwo carbon atoms and at least one carbon-carbon triple bond.

An “aryl” group refers to an all-carbon monocyclic or fused-ringpolycyclic (i.e., rings which share adjacent pairs of (carbon atoms)groups having a completely conjugated pi-electron system. Examples,without limitation, of aryl groups are phenyl, naphthalenyl andanthracenyl. The aryl group may be substituted or unsubstituted.

A “heteroaryl” group refers to a monocyclic or fused ring (i.e., ringswhich share an adjacent pair of atoms) group having in the ring(s) oneor more atoms, such as, for example, nitrogen, oxygen and sulfur and, inaddition, having a completely conjugated pi-electron system. Examples,without limitation, of heteroaryl groups include pyrrole, furane,thiophene, imidazole, oxazole, thiazole, pyrazole, pyridine, pyrimidine,quinoline, isoquinoline and purine.

A “heteroalicyclic” group refers to a monocyclic or fused ring grouphaving in the ring(s) one or more atoms such as nitrogen, oxygen andsulfur. The rings may also have one or more double bonds. However, therings do not have a completely conjugated pi-electron system. Theheteroalicyclic may be substituted or unsubstituted. Representativeexamples are piperidine, piperazine, tetrahydrofurane, tetrahydropyrane,morpholino and the like.

A “hydroxy” group refers to an —OH group.

An “alkoxy” group refers to both an —O-alkyl and an —O-cycloalkyl group,as defined herein.

An “aryloxy” group refers to both am —O-aryl and an —O-heteroaryl group,as defined herein.

A “thiohydroxy” group refers to a —SH group.

A “thioalkoxy” group refers to both an —S-alkyl group, and an—S-cycloalkyl group, as defined herein.

A “thioaryloxy” group refers to both an —S-aryl and an —S-heteroarylgroup, as defined herein.

A “carbonyl” group refers to a —C(═O)—R′ group, where R′ is hydrogen,alkyl, alkenyl, cycloalkyl, aryl, heteroaryl (bonded through a ringcarbon) or heteroalicyclic (bonded through a ring carbon) as definedherein.

A “thiocarbonyl” group refers to a —C(═S)—R′ group, where R′ is asdefined herein for R′.

A “C-carboxy” group refers to a —C(═O)—O—R′ group, where R′ is asdefined herein.

An “O-carboxy” group refers to an R′C(═O)—O— group, where R′ is asdefined herein.

A “halide” group refers to fluorine, chlorine, bromine or iodine.

A “sulfinyl” group refers to an —S(═O)—R′ group, where R′ is as definedherein.

A “sulfonyl” group refers to an —S(═O)₂—R′ group, where R′ is as definedherein.

An “S-sulfonamido” group refers to a —S(═O)₂—NR′R″ group, with R′ is asdefined herein and R″ is as defined for R′.

An “N-sulfonamido” group refers to an R′S(═O)₂—NR″ group, where R′ andR″ are as defined herein.

An “O-carbamyl” group refers to an —OC(═O)—NR′R″ group, where R′ and R″are as defined herein.

An “N-carbamyl” group refers to R″OC(═O)—NR′— group, where R′ and R″ areas defined herein.

An “O-thiocarbamyl” group refers to an —OC(═S)—NR′R″ group, where R′ andR″ are as defined herein.

An “N-thiocarbamyl” group refers to an R″OC(═S)NR′— group, where R′ andR″ are as defined herein.

An “amino” group refers to an —NR′R″ group where R′ and R″ are asdefined herein.

A “C-amido” group refers to a —(C(═O)—NR′R″ group, where R′ and R″ areas defined herein.

An “N-amido” group refers to an R′C(═O)—NR″ group, where R′ and R″ areas defined herein.

A “urea” group refers to an —NR′C(═O)—NR″R′″ group, where R′ and R″ areas defined herein and R′″ is defined as either R′ or R″.

A “guanidino” group refers to an —R′R″NC(═N)—NR″R′″ group, where R′, R″and R′″ are as defined herein.

A “guanyl” group refers to an R′R″NC(═N)— group, where R′ and R″ are asdefined herein.

A “nitro” group refers to an —NO₂ group.

A “cyano” group refers to a —C≡H group.

The term “phosphonyl” describes a —O—P(═O)(OR′)(OR″) group, with R′ andR″ as defined hereinabove.

The term “phosphinyl” describes a —PR′R″ group, with R′ and R″ asdefined hereinabove.

The term “thiourea” describes a —NR′—C(═S)—NR″R′″ group, with R′ and R″as defined hereinabove and R′″ as defined herein for R′ and R″.

In any of the methods described herein, the H₁ agonist can beadministered by any route selected from the oral, transdermal,intravenous, subcutaneous, intramuscular, intranasal, intraauricular,sublingual, rectal, transmucosal, intestinal, buccal, intramedullar,intrathecal, direct intraventricular, intraperitoneal, or intraocularroutes. Preferably, the route of administration is selected from theoral, transdermal, buccal, transmucosal, rectal or sublingual routes.More preferably, the H₁ agonist is administered using the oral, buccalor transdermal route.

The H₁ agonist is optionally and preferably administered as a total doseof from about 2 mg to about 96 mg per day. More preferably, the totaldose is from about 5 mg to about 50 mg per day, more preferably fromabout 10 mg to about 50 mg, more preferably from about 16 mg to about 48mg and most preferably it is from about 24 mg to 48 mg.

The H₁ agonist is preferably administered once or several times a day,for example from about 1 to about 4 times per day, and, more preferably,twice per day. Alternatively, the H₁ agonist may be administeredaccording to the development of hunger of the subject.

As is demonstrated in the Examples section that follows, clinicalstudies have indicated that administering a 16 mg dose of betahistinetwice a day for a month, without restricting their food intake, resultedin a significant weight loss, particularly as compared with a controlgroup.

Hence, according to an embodiment of the present invention, a treatmentregime is performed such that upon repetitious administration, adecrease of the body weight of the subject that ranges from about 1 toabout 5 percent is effected, without restricting the food intake of thesubject.

Since, as is discussed in detail hereinabove, constant presence of a H₁agonist may result in substantial downregulation of the H₁ receptor, amore preferred treatment regime according to the present invention isperformed such that such a decrease in a body weight is achieved withouteffecting downregulation of the H₁ receptor. Such a treatment regime canbe designed by adjusting the dosing and the administration intervals tothe half life of the selected H1 agonist.

The dosage may vary depending upon the dosage form employed and theroute of administration utilized. The exact formulation, route ofadministration and dosage can be chosen by the individual physician inview of the patient's condition. (See e.g., Fingl, et al., 1975, in “ThePharmacological Basis of Therapeutics”, Ch. 1 p. 1). Dosage amount andinterval may be adjusted individually to provide plasma levels of the H₁agonist which are sufficient to maintain the regulating effects.

When the H₁ agonist is betahistine, which is commercially available astablets of 8 mg or 16 mg, the daily dosage range is from 24 to 48 mg,administered orally in divided doses. For example, the 8 mg tablet isadministered as 1 to 2 tablets 3 times daily, and the 16 mg tablet isadministered as 0.5 to 1 tablet 3 times daily.

The H₁ agonist of the present invention may optionally be administeredin the form of a slow-release preparation, having a reduced rate ofrelease of the active substance, in order to further increase patientconvenience and compliance and optionally the efficiency of the activeagent. The slower the rate of release, the less the blood concentrationsfluctuate within a dosing interval. This enables higher doses to begiven less frequently, while maintaining therapeutic concentrations overprolonged periods. Furthermore, slow-release preparations are beneficialin reducing potential side-effects of the active ingredient due totransiently high peak blood concentrations being reached soon afteradministration.

Slow release preparations typically include slow release biodegradablecarriers. Slow release biodegradable carriers are well known in the art.These are materials that may form particles that may capture therein anactive compound(s) and slowly degrade/dissolve under a suitableenvironment (e.g., aqueous, acidic, basic, etc.) and therebydegrade/dissolve in body fluids and release the active compound(s)therein. The particles are preferably nanoparticles (i.e., in thenanometer range, e.g., in the range of about 1 to about 500 nm indiameter, preferably about 50-200 nm in diameter, most preferably about100 nm in diameter).

The rate at which a drug is released is generally dependent on the rateat which the dosage form disintegrates or dissolves. Disintegrationgreatly increases the drug's surface area in contact with GI fluids,thereby promoting drug dissolution and absorption. Disintegrants andother excipients (e.g., diluents, lubricants, surfactants, binders,dispersants) are often added during manufacture to facilitate theseprocesses. Surfactants increase the dissolution rate by increasing thewettability, solubility, and dispersibility of the drug. Disintegrationof solid forms may be retarded by excessive pressure applied during thetableting procedure or by special coatings applied to protect the tabletfrom the digestive processes of the gut. Hydrophobic lubricants (e.g.,magnesium stearate) may bind to the active drug and reduce itsbioavailability.

Dissolution rate determines the availability of the drug for absorption.When slower than absorption, dissolution becomes the rate-limiting step.Overall absorption can be controlled by manipulating the formulation.For example, reducing the particle size increases the drug's surfacearea, thus increasing the rate and extent of GI absorption of a drugwhose absorption is normally limited by slow dissolution. Dissolutionrate is affected by whether the drug is in salt, crystal, or hydrateform.

Oral slow-release forms are often designed to maintain therapeutic drugconcentrations for greater than 12 hours. The absorption rate can becontrolled by coating drug particles with wax or other water-insolublematerial, by embedding the drug in a matrix from which it is releasedslowly during transit through the GI tract, or by complexing the drugwith ion-exchange resins.

Thus, for example, a slow-release formulation in tablet form, may bebased on the use of a hydrophilic polymer which swells in contact withgastrointestinal fluids, to form a gel, which creates a barrier thatenrobes the tablet. The barrier limits physical exchanges between theinside of the tablet and the surrounding medium. As a consequence,intrusion of water towards the tablet matrix and diffusion of drug areslowed down, allowing a controlled slow release of the drug.

Various types of polymers may be used as a matrix for the slow-releaseof drugs, such as polyvinyl chloride, polyethylene polyamides,ethylcellulose, silicone, poly(hydroxyethyl methacrylate), other acrylicco-polymers, and polyvinylacetate-polyvinyl chloride copolymers.

Thus, a slow-release formulation for delivery of the H₁ agonist of thepresent invention provides for release over a period that ranges fromabout 2 hour to about 24 hours, preferably from about 4 hours to about24 hours and hence, for release over a period of at least 4 hour, atleast 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, atleast 9 hours, at least 10 hours, it least 11 hours, at least 12 hours,at least 13 hours, at least 14 hours, at least 15 hours, at least 16hours, at least 17 hours, at least 18 hours, at least 19 hours, at least20 hours, at least 21 hours, at least 22 hours, at least 23 hours, or atleast 24 hours. Alternatively, such a slow-release formulation providesfor release of the H₁ agonist over a period of more than 24 hours and upto 48 hours.

The method according to this aspect of the present invention can thus beefficiently used for treating any condition in which regulating foodintake is beneficial. These include, for example, overeating,overweight, obesity, and disorders caused or exacerbated thereby.

Diseases caused by or exacerbated by these conditions include, forexample, muscosceletal disorders (such as osteoarthritis, spine-relatedpains, etc.), cardiovascular disorders (such as hypertension,atherosclerosis, etc.), dermatological disorders (such as fungal andother infections), sleep disorder (such as snoring and obstructive sleepapnea), metabolic conditions (dyslipidemia, lipemia orhypercholesterolemia), diabetes and diabetes-related problems, as wellas cancer (particularly breast, prostate and colon cancer). The effectof overweight, expressed by the body mass index, on the relative risk ofdeath from various disorders caused or exacerbated thereby, isdemonstrated in FIG. 3. As shown in FIG. 3, cardiovascular diseaseincreases significantly in overweight subjects, both male and female, ascompared to those within the normal body-mass index range (i.e. from18.5 to 24.9). A further sharp increase is observed in subjectsclassified as obese (i.e. having body mass of greater than 30).Similarly, an increase in the relative risk of death from cancer is seenin overweight subjects, particularly in obese subjects, with a greaterincrease amongst females. The relative risk of death from other causesis seen to increase sharply in obese individuals.

Additional conditions that are treatable by the method according to thisaspect of the present invention include, for example, conditions thatare associated with a psychological factor, such as binge eatingdisorder, night eating syndrome, obsessive eating, compulsive eating andbulimia.

Bulimia is a psychological condition in which the subject engages inrecurrent binge eating followed by intentionally doing one or more ofthe following in order to compensate for the intake of the food andprevent weight gain: vomiting; inappropriate use of laxatives, enemas,diuretics or other medication; excessive exercising; fasting. Someanorectics may demonstrate bulimic behaviors in their illness:binge-eating and purging themselves of food on a regular or infrequentbasis at certain times during the course of their disease. Bulimia mayoccur without the serious weight loss which is symptomatic of anorexia.An increase in binge eating has been reported amongst patients receivingatypical antipsychotics (Theisen, 2003), apparently as a result ofattempts to compensate for weight gain induced by the antipsychotic. Theuse of betahistine to avoid this weight gain may therefore be beneficialin preventing the resulting compensatory behavior which leads tobulimia. Furthermore, the reduction in appetite resulting fromadministration of betahistine further contributes to the prevention ofthe overeating/purging cycle which characterizes bulimia.

As is detailed hereinbelow, it has been suggested that the H₁ agonistdescribed herein interferes with appetite-stimulating histaminergicactivity of steroidal or anti-psychotic drugs.

Peptide YY (PYY) is a peptide with 36 amino acids that originates fromthe intestine. Studies have shown that elevated PYY levels were detectedin patients suffering from eating disorders. (Hagan, 2002). In addition,thioperamide, an H₃ antagonist, has been shown to block the ability ofincreased levels of PYY to increase food consumption (Itoh, 1999). SinceH₃ antagonists increase neuronal histamine levels and since thisincreased histamine binds to H₁ receptors, the H₁ agonist describedherein can be further efficiently used in treating such eating disordersvia its histaminergic activity.

Hence, according to another aspect of the present invention there isprovided a method of treating an eating disorder, and particularlybulimia. The method according to this aspect of the present invention iseffected by administering to a subject suffering from an eating disordersuch as bulimia a therapeutically effective amount of the H₁ agonistdescribed herein.

The H₁ agonist described herein may be further utilized for preventingor at least reducing weight gain, and preferably weight gain caused byfactors other than excessive food consumption.

Thus, according to a further aspect of the present invention, there isprovided a method of preventing or reducing weight gain, which iseffected by administering to the subject a therapeutically effectiveamount of an H₁ agonist that has a pharmacological half-life of at least3 hours, as described hereinabove.

Such weight gain may be due to factors which include, for example, useof certain drugs, cessation of smoking, or due to a holiday season, asdiscussed hereinabove and is further detailed hereinbelow.

Thus, in one embodiment, the method according to this aspect of thepresent invention, can be implemented to reduce or prevent weight gainassociated with drug treatment.

Presently, many drugs are known to cause weight gain. Representativeexamples include, without limitation, antipsychotics, antidepressants,mood-stabilizers, calcium channel blockers, anti-convulsants, protonpump inhibitors, antidiabetic agents, antihypertensives, hormones, andanti-smoking medications.

As is described in the art, the histaminergic system has been implicatedin weight gain associated with steroid-induced and antipsychotic-inducedweight gain (Poyurovsky et al., 2005). Hence, the H₁-receptor agonistsof the present invention may be co-administered together with a drugtreatment which is known to cause appetite stimulation and weight gainin humans due to its histaminergic activity. It is assumed that the H₁agonist utilized herein interferes with appetite stimulatinghistaminergic activity of the steroidal or anti-psychotic drug mentionedabove and thus prevents or reduces the weight gain caused by such drugtreatment.

Representative examples of antipsychotic drugs associated with weightgain include, without limitation, selective serotonin-reuptakeinhibitors (SSRIs) (such as fluvoxamine, escitalopram, citalopram, orparoxetine), monoamine oxidase inhibitors (such as isocarboxazid,phenelzine and tranylcypromine), conventional antipsychotics (such ashaloperidol, molindone and thioridazine), and atypical antipsychotics,(such as clozapine, olanzapine, risperidone, quetiapine, sertindole,aripiprazole and ziprasidone. Particular examples of antipsychotic drugsassociated with weight gain are those which are antagonists of serotoninreceptors, including 5-HT_(2A), and 5-HT_(2C) subtypes, or ofH₁-histaminergic, and M₁-muscarinic receptors. These include, forexample, clozapine, olanzapine, risperidione and pirenzepine.

As discussed hereinabove, the mechanisms by which antipsychotic drugscause weight gain are not clear, but appear to involve multiple effectson neurotransmitter systems, such as the serotogenic, histaminergic, andadrenergic systems.

Atypical antipsychotics, particularly clozapine, olanzapine,risperidone, and quietiapine, have been shown to cause a higher increasein weight gain than conventional antipsychotics. The effect of theseantipsychotics may involve both appetite stimulation by a direct effecton the brain, and a delayed endocrine/metabolic dysfunction thatpromotes fat deposition. One study (Poyurovsky 2005) has identified anattenuating effect of betahistine on weight gain due to olanzapine, fromweek 2 to the end of the study. Since olanzapine is a potent H₁antagonist, and betahistine was found not to interfere with theantipsychotic effect of olanzapine, it has been suggested that theantagonistic effect of betahistine on the presynaptic H₃ receptor mayaccount for the weight gain attenuation.

Weight gain may also occur due to the use of hormones, particularlysteroid hormones, such as corticosteroids or sex steroids.Corticosteroids include glucocorticoids, (for example, prednisone andcortisol), and mineralocorticoids (for example, aldosterone andfludrocortisone). Sex steroids include androgens (for example,testosterone and dehydroepiandrosterone), estrogens (such as estradiol),and progestagens, (for example, progesterone and progestin). Estrogensand progestagens are administered as oral contraceptives. Estrogen andprogestin are administered as hormone replacement therapy for menopausalwomen.

Other drugs which may cause weight gain include antidepressants,including, for example, tricyclic antidepressants (such asamitryptyline, amoxapine, clomiprmine, desipramine, doxepin, imipramine,nortryptyline, protriptyline and trimipramine), tetracyclicantidepressants (such as mirtazapine and maprotiline),serotonin-norepinephrine reuptake inhibitors (such as venlafaxine andduloxetine), and other anti-depressants (such as biproprionhydrochloride, mitrazapine, nefazadone and trazadone); mood-stabilizers,such as lithium; calcium channel blockers (such as diltiazem,nicardipine, verapamil and nimopidipine); anti-convulsants (such ascarbamazepine, divalproex, lamotrigine, sodium valproate, valproic acid,and gabapentin); proton pump inhibitors (such as omeprazole,esomeprazole, lansoprazole and pantoprazole); antidiabetic agents, suchas sulfonylureas (for example, chlorpropamide, glipizide, glyburide, andglimepiride); and antihypertensives, such as alpha-adrenergic blockers,(for example, prazosin, doxazosin or terazosin), or beta blockers, (forexample, acebutolol, atenolol, metoprolol, nadolol, pindolol andpropanolol).

As discussed in the Background section hereinabove, weight gainassociated with use of certain drugs may be due to, for example, foodcravings, decreased exercise capacity, or stimulation of appetite, forexample by blocking of histamine receptors. Involvement of 5-HT_(2A),5-HT_(2C), H₁-histaminergic, and M₁-muscarinic receptors in weight gainhas also been described.

In another embodiment, the method according to this aspect of thepresent invention, can be implemented to reduce or prevent weight gainassociated with smoking cessation.

Weight gain associated with cessation of smoking may be attributed, forexample, to the fact that nicotine increases heart rate and increasesmetabolism, such that readjustment to a lower metabolic rate is requiredonce nicotine is no longer present in the bloodstream; to the fact thatnicotine is an appetite suppressant; and to the need for emotionalcomfort in a subject suffering from the unpleasant symptoms associatedwith nicotine withdrawal.

Weight gain associated with cessation of smoking may also occur due tothe use of drugs in this respect. Presently, there are a few drugs thatare given in this respect. These include, for example,nicotine-replacement products, such as nicotine patches, nicotine gum(nicotine polacrilex), nicotine inhaler, and nicotine nasal spray, aswell as the newer non-nicotine-based, medications, such as Zyban™(bupropion hydrochloride), and future therapies such as Cannabioindreceptor affecting Acomplia™ (rimonabant). Administration of the H₁agonist described herein can be effected in combination with any ofthese and other drugs for smoking cessation.

Weight gain also frequently occurs during a holiday season. This may bedue to the fact that with greater leisure time at his disposal, asubject has more opportunity to eat more frequently, or becausepartaking of elaborate meals is often an integral part of a holidaycelebration. This is exacerbated by holidays, particularly religious ornational holidays, which are associated with festive meals, orconsumption of particular kinds of food. These include, for example, thefestive Thanksgiving meal, Christmas dinner, the Jewish Passover meal,and the like.

The H₁-receptor agonists described herein can be further efficientlyused for improving a compliance of a human subject to caloricrestriction. Thus, according to another aspect of the present invention,there is provided a method of improving a compliance of a human subjectto caloric restriction, which is effected by administering to thesubject a therapeutically effective amount of an H₁ agonist as describedherein. The method, according to this aspect of the present inventioncan be beneficially practiced with human subject undergoing a weightreducing diet or any other caloric restriction.

By efficiently regulating food intake in human subjects and improving acompliance thereof to caloric restriction the methods describedhereinabove may further be used for inducing weight loss, formaintaining weight loss or preventing a weight gain after or during aweight reducing diet, or for preventing weight gain in a subject havinga condition associated with weight gain. For inducing or maintainingweight loss, the H₁ receptor agonist of the present invention mayoptionally be administered in conjunction with other methods oftreatment, such as diet, exercise, behavioral therapy, drug therapy, orsurgical therapy.

The H₁-receptor agonists described herein can be further efficientlyused for reducing a desire of a human subject to consume fats. Someneurotransmitters and neuromodulators have been shown to control bothamount eaten and selection of food in a mancronutrient specific manner(Lecklin et al., 2002). For example, as is discussed hereinabove and isfurther demonstrated in FIGS. 1 and 2, metoprine has been shown tosuppress daily ingestion of fats in rats, while having no effect onintakes of carbohydrates or proteins, indicating that an increase in thebrain histamine content may specifically affect the desire to consumefats.

As is demonstrated in the Examples section that follows, it has beenfound that betahistine treatment resulted in a significant decrease infat consumption in human subjects over a 28 day trial, while consumptionof carbohydrates was not significantly altered. The increase in brainhistamine caused by administration of the H₁-receptor agonists of thepresent invention may therefore be effective in reducing the desire of ahuman subject to consume fats.

Thus, according to still another aspect of the present invention, thereis provided a method of reducing the desire of a human subject toconsume fats, which is effected by administering to the subject atherapeutically effective amount of the H₁ agonist described herein.

The clinical finding that the H₁ agonist of the present inventionreduces fat intake in humans is of unique importance, not only withregard to obese subjects, but also with regard to patients sufferingfrom conditions that are associated with fat consumption and/or in whichreduced fat consumption is beneficial.

Thus, according to a further aspect of the present invention, there isprovided a method of treating a condition in which reduced fatconsumption is beneficial, which is effected by administering to asubject in need thereof a therapeutically effective amount of an H₁agonist, as described herein.

Reducing the fat consumption of a subject can be further utilized fortreating conditions associated with metabolic derangement.

Thus, according to still another aspect of the present invention, thereis provided a method of treating a condition associated with a metabolicderangement in a human subject, which is effected by administering tothe subject a therapeutically effective amount of the H₁ agonistdescribed herein.

Such conditions are typically associated with metabolic derangement andmore particularly with adverse imbalance of metabolites such as totalcholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and thelike and include, for example, dyslipidemia, such ashypercholesterolemia or lipemia and diabetes.

Dyslipidemias are disorders of lipoprotein metabolism, includinglipoprotein overproduction or deficiency. These disorders may bemanifested by elevation of the serum total cholesterol, low-densitylipoprotein (LDL) cholesterol and triglyceride concentrations, and adecrease in the high-density lipoprotein (HDL) cholesterol concentrationand therefore include, for example, lipemia and hypercholesterolemia.

Lipemia is a condition in which an excess of fats or lipids is found inthe blood of subject.

Hypercholesterolemia is a condition in which high levels of cholesterolare found in the blood of a subject.

A direct connection has been shown between coronary artery disease anddyslipidemia. Dyslipidemias may be genetic in origin, or may be due todietary factors (such as excess saturated fats, “trans” fatty acids,cholesterol, excess calories, or alcohol) or drug use (including steroidhormones, diuretics, beta-blockers, cyclosporine and amiodarone, orolanzapine). Dyslipidemias may also be associated with hypothyroidism,diabetes mellitus, hepatobiliary obstruction, nephritic syndrome andchronic renal failure, or with systemic diseases such as porphyries,systemic lupus erythematosis, and lymphomas. The most commonly usedoptions for pharmacologic treatment of dyslipidemia include fibrates,HMG-CoA reductase inhibitors (such as statins), bile acid sequestrants,cholesterol absorption inhibitors, nicotinic acid and derivativesthereof.

High cholesterol level, as well as other manifestations of dyslipidemia,can cause the formation and accumulation of plaque deposits in thearteries, leading to plaque ruptures and blockages in the arteries,which increase the risk for heart attack, stroke, circulation problems,and death. Patients suffering from metabolic derangement that ismanifested by dyslipidemia are therefore typically instructed to followa low fat diet as a first measure, before being prescribed drugs whichaffect cholesterol metabolism. However, patient compliance with theseinstructions is generally not high, and currently there are no availabledrugs for helping patients to adhere to such a diet. Therefore, the H₁agonist of the present invention, in reducing the desire of a patient toconsume fats, helps such patients to maintain a low fat diet.

Hence, according to still another aspect of the present invention, thereis provided a method of reducing total cholesterol level in a humansubject, which is effected by administering to the subject atherapeutically effective amount of the H₁ agonist described herein.

Total cholesterol consists of HDL cholesterol and LDL cholesterol. Highdensity lipoprotein (HDL), commonly referred to as “good” cholesterol,tends to carry cholesterol away from the arteries and back to the liver,where it is passed from the body. It is also believed that HDLcholesterol removes excess cholesterol from plaque in arteries, thusslowing the buildup. An increase in HDL cholesterol is thereforeconsidered beneficial. In contrast, LDL cholesterol is considered to be“bad” cholesterol, being responsible for plaque formation and deposits.Reducing LDL-cholesterol is believed to be responsible for reducing orstopping the formation of new cholesterol plaques on the artery walls;reducing existing cholesterol plaques on the artery walls; wideningnarrowed arteries; preventing the rupture of cholesterol plaques, whichinitiates blood clot formation; decreasing the risk of heart attacks;and decreasing the risk of strokes.

Thus, according to still another aspect of the present invention, thereis provided a method of reducing low-density lipoprotein cholesterol andincreasing high-density lipoprotein cholesterol levels in a humansubject, which is effected by administering to the subject atherapeutically effective amount of the H₁ agonist described herein.

Triglycerides are common types of fats (lipids) that are essential forgood health when present in normal amounts. They account for about 95percent of the body's fatty tissue. Triglycerides are both present infood and manufactured by the body. Abnormally high triglyceride levelsare associated with a number of diseases and conditions, such ascirrhosis, underactive thyroid, poorly controlled diabetes, andpancreatitis. High triglyceride levels are, also associated with knownrisk factors for heart disease, such as low levels of HDL cholesterol,high levels of LDL cholesterol and obesity. Triglycerides may alsocontribute to atherosclerosis.

Hence, according to still another aspect of the present invention, thereis provided a method of reducing triglyceride level in a human subject,which is effected by administering to the subject a therapeuticallyeffective amount of the H₁ agonist described herein.

In any of the methods described herein, the H₁ agonist may optionally beadministered together with a therapeutically effective amount of anadditional active agent that may affect the condition being treated.

According to a preferred embodiment of the present invention, theadditional active ingredient can be, for example, a weight controlagent. Any of the presently known and approved weight control agents orrelated substances can be used according to this embodiment. Hence,representative examples of such active ingredients include, for example,lipase inhibitors. A non-limiting example of a lipase inhibitor suitablefor co-administration with the H₁ agonist of the present invention isOrlistat, which acts by binding to gastrointestinal lipases in the lumenof the gut, preventing hydrolysis of dietary fat into absorbable freefatty acids and monoacylglycerols. Orlistat is currently the onlyFDA-approved medication for obesity that reduces nutrient absorption.

Additional examples of such active ingredients include Sibrutamine, aninhibitor of both norepinephrine reuptake and serotonin reuptake thatalso weakly inhibits dopamine reuptake, which is approved by the FDA forweight loss and weight maintenance in conjunction with a reduction diet.Additional examples of such active ingredients include amphetamines,although the administration thereof might be restricted to a limitedtime period. A. non-limiting example of an amphetamine suitable forco-administration with the H₁ agonist of the present invention isFentermine.

Additional examples of such active ingredients include canabinoidreceptor antagonists. A non-limiting example of a canabinoid receptorantagonist suitable for co-administration with the H₁ agonist of thepresent invention is Rimonabant, a recently developed drug that iscurrently undergoing Phase III trials and which is claimed to stop foodcravings.

Alternatively, the additional active agent may be an agent for thetreatment of a musculoskeletal disorder, a cardiovascular disorder, adermatological disorder, a sleep disorder, a metabolic condition,dyslipidemia (including hypercholesterolemia and lipemia), diabetes or adiabetes-related condition. Such agents are not necessarily associatedwith weight gain, but may be administered together with the H₁ agonistof the present invention, for treatment of additional conditions fromwhich the subject may suffer.

Representative examples of agents for the treatment of musculoskeletaldisorders include, without limitation, anti-inflammatory agents,including non-steroidal anti-inflammatory drugs, muscle relaxants,anti-gout agents (such as allopurinol, colchicine, and uricosuricdrugs), immunosuppressants (such as glucocorticoids, gold, and cytotoxicagents) and drugs affecting bone mineralization (e.g., diphosphonates,calcitonin, estrogen analogs).

Representative examples of non-steroidal anti-inflammatory drugsinclude, without limitation, piroxicam, isoxicam, tenoxicam, sudoxicam,and CP-14,304; salicylates, such as aspirin, disalcid, benorylate,trilisate, safapryn, solprin, diflunisal, and fendosal; acetic acidderivatives, such as diclofenac, fenclofenac, indomethacin, sulindac,tolmetin, isoxepac, furofenac, tiopinac, zidometacin, acematacin,fentiazac, zomepirac, clindanac, oxepinac, felbinac, and ketorolac;fenamates, such as mefenamic, meclofenamic, flufenamic, niflumic, andtolfenamic acids; propionic acid derivatives, such as ibuprofen,naproxen, benoxaprofen, flurbiprofen, ketoprofen, fenoprofen, fenbufen,indopropfen, pirprofen, carprofen, oxaprozin, pranoprofen, miroprofen,tioxaprofen, suprofen, alminoprofen, and tiaprofenic; pyrazoles, such asphenylbutazone, oxyphenbutazone, feprazone, azapropazone, andtrimethazone.

Non-limiting examples of steroidal anti-inflammatory drugs include,without limitation, corticosteroids such as hydrocortisone,hydroxyltriamcinolone, alpha-methyl dexamethasone,dexamethasone-phosphate, beclomethasone dipropionates, clobetasolvalerate, desonide, desoxymethasone, desoxycorticosterone acetate,dexamethasone, dichlorisone, diflorasone diacetate, diflucortolonevalerate, fluadrenolone, fluclorolone acetonide, fludrocortisone,flumethasone pivalate, fluosinolone acetonide, fluocinonide, flucortinebutylesters, fluocortolone, fluprednidene(fluprednylidene)acetate,flurandrenolone, halcinonide, hydrocortisone acetate, hydrocortisonebutyrate, methylprednisolone, triamcinolone acetonide, cortisone,cortodoxone, flucetonide, fludrocortisone, difluorosone diacetate,fluradrenolone, fludrocortisone, diflurosone diacetate, fluradrenoloneacetonide, medrysone, amcinafel, amcinafide, betamethasone and thebalance of its esters, chloroprednisone, chlorprednisone acetate,clocortelone, clescinolone, dichlorisone, diflurprednate, flucloronide,flunisolide, fluoromethalone, fluperolone, fluprednisolone,hydrocortisone valerate, hydrocortisone cyclopentylpropionate,hydrocortamate, meprednisone, paramethasone, prednisolone, prednisone,beclomethasone dipropionate, triamcinolone, and mixtures thereof.

Representative examples of agents for the treatment of cardiovasculardisorder include, without limitation,; angiotensin-converting enzymeinhibitors (such as captopril, enalapril, or lisinopril); antiarrhythmicdrugs (such as amiodarone); anticoagulants, antiplatelets orthrombolytics (such as aspirin); centrally acting drugs (such asclonidine, guanfacine or methyldopa); digitalis drugs (such as digoxin);diuretics (such as chlorthalidone); nitrates (such as nitroglycerin);peripheral adrenergic antagonists (such as reserpine); and vasodilators(such as hydralazine).

Representative examples of agents for the treatment of sleep disordersinclude, without limitation, hypnotic medications, such asbenzodiazepines (including flurazepam, estazolam, temazepam andtriazolam); zaleplon and zolpidem; eszopiclone; antidepressants, such istrazodone, antihistamines (such as diphenhydramine products).

Representative examples of agents for the treatment of diabetes include,without limitation, a meglitinide (such as repaglinide or nateglinide),a biguanide (such as metformin), a thiazolidinedione (such asrosiglitazone, troglitazone or pioglitazone), and an alpha-glucosidaseinhibitor (such as acarbose or meglitol) and insulin.

Non-limiting examples of agents for the treatment of dyslipidemiainclude agents that lower serum total cholesterol, low-densitylipoprotein (LDL) cholesterol and triglyceride concentrations such as,for example, fibrates, HMG-CoA reductase inhibitors, bile acidsequestrants, cholesterol absorption inhibitors including triglycerideabsorption inhibitors, cholesterol biosynthesis inhibitors, includingtriglycerides absorption inhibitors, nicotinic acid and any analogs,metabolites and derivatives thereof.

HMG-CoA reductase inhibitors (statins) are well known drugs thateffectively reduce LDL-cholesterol levels by inhibiting the enzyme thatregulates the rate of cholesterol production and increasing theclearance of LDL-cholesterol present in the blood by the liver.Representative examples of commonly prescribed statins includeAtorvastatin, Fluvastatin, Lovastatin, Pravastatin and Simvastatin.

Proliferative Activated Receptor (PPAR) agonists, also known asfibrates, are fatty acid-activated members of the nuclear receptorsuperfamily that play important roles in lipid and glucose metabolism,and have been implicated in obesity-related metabolic diseases such ashyperlipidemia, insulin resistance, and coronary artery disease.Fibrates are generally effective in lowering elevated plasmatriglycerides and cholesterol and act as PPAR agonists. The mostpronounced effect of fibrates includes a decrease in plasmatriglyceride-rich lipoproteins (TRLs). Levels of LDL cholesterol (LDL-C)generally decrease in individuals with elevated baseline plasmaconcentrations, and HDL cholesterol (HDL-C) levels are usually increasedwhen baseline plasma concentrations are low. Non-limiting examples ofcommonly prescribed fibrates include bezafibrate, gemfibrozil andfenofibrate.

Representative examples of cholesterol absorption inhibitors includeezetimibe. Ezetimibe is the first of a new class of cholesterolabsorption inhibitors that potently and selectively inhibits dietary andbiliary cholesterol absorption at the brush border of the intestinalepithelium, without affecting the absorption of triglyceride orfat-soluble vitamins. Ezetimibe thus reduces overall cholesteroldelivery to the liver, secondarily inducing increased expression of LDLreceptors, resulting in an increased removal of LDL-C from the plasma.

Cholesterol absorption may also be affected by Cholesteryl EsterTransfer Protein (CETP) inhibitors, which play a major role inatherogenesis, by reducing cholesteryl ester accumulation withinmacrophages and the arterial wall, and thus reducing foam cell formationand affecting the cholesterol absorption. The most promising presentlyknown CETP inhibitor is avisimibe.

Bile acid sequestrants are a class of cholesterol lowering drugs thathelp rid the body of cholesterol by depleting cholesterol levels in thebody. Bile is released from the liver and aids in the emulsification offats. Cholesterol is a major component of bile, and most of thecholesterol from bile is reabsorbed into the bloodstream in the smallintestine. Bile acid sequestrants act at the level of the smallintestine and function in binding to bile, thus preventing cholesterolfrom being reabsorbed into circulation. Instead, the medication and bilewill form an insoluble complex and be excreted in the feces. Examples ofcommonly prescribed bile acid sequesterants include Cholestyramine(Questran®) and colestipol (Colestid®).

Representative examples of (cholesterol biosynthesis inhibitors includesqualene inhibitors (such as monooxygenase and synthase). Squalene is anisoprenoid compound structurally similar to beta-carotene, is anintermediate metabolite in the synthesis of cholesterol. In humans,about 60 percent of dietary squalene is absorbed. It is transported inserum generally in association with very low density lipoproteins and isdistributed ubiquitously in human tissues, with the greatestconcentration in the skin, where it is one of the major components ofskin surface lipids. Squalene inhibitors (e.g., monooxygenase andsynthase) serve as cholesterol biosynthesis inhibitors.

Nicotinic acid is a known agent that lowers total cholesterol,LDL-cholesterol, and triglyceride levels, while raising HDL-cholesterollevels. There are three types of nicotinic acid drugs: immediaterelease, timed release, and extended release. Nicotinic acid or niacin,the water-soluble B vitamin, improves all lipoproteins when given indoses well above the vitamin requirement.

Additional active agents that can be utilized according to thisembodiment of the present invention include, for example, analgesics,growth factors and toxins.

Non-limiting examples of analgesics (pain relievers) include aspirin andother salicylates (such as choline or magnesium salicylate), ibuprofen,ketoprofen, naproxen sodium, and acetaminophen.

Growth factors are hormones which have numerous functions, includingregulation of adhesion molecule production, altering cellularproliferation, increasing vascularization, enhancing collagen synthesis,regulating bone metabolism and altering migration of cells into givenarea. Non-limiting examples of growth factors include insulin-likegrowth factor-1 (IGF-1), transforming growth factor-β (TGF-β), a bonemorphogenic protein (BMP) and the like.

Non-limiting examples of toxins include the cholera toxin, which alsoserves as an adjuvant.

When utilized in each of the methods and aspects described above, the H₁agonist of the present invention optionally and preferably forms a partof a pharmaceutical composition. The pharmaceutical compositioncomprises, in addition to the H₁ agonist, a pharmaceutically acceptablecarrier, and may optionally further comprise one or more componentsselected from binding agents, stabilizers, diluents, excipients,surfactants, flavors, and odorants.

As used herein a “pharmaceutical composition” refers to a preparation ofone or more of the active ingredients described herein, either compoundsor physiologically acceptable salts thereof, with other chemicalcomponents such as traditional drugs, physiologically suitable carriersand excipients. Thus, a pharmaceutical composition, according to thepresent embodiments, can include the H₁ agonist described herein, eitheras the sole active ingredient, or combined with any of the activeingredients described herein, including, for example, weight controlagents, drugs that a treatment therewith is associated with weight gain(e.g., antipsychotics, antidepressants and the like), agents for thetreatment of a musculoskeletal disorder, a cardiovascular disorder, adermatological disorder, a sleep disorder, a metabolic condition,diabetes or a diabetes-related condition, and agents for treatingdyslipidemia (including lipemia and hypercholesterolemia, e.g.,cholesterol and/or triglycerides absorption inhibitors and cholesteroland/or triglycerides biosynthesis inhibitors), all is is detailedhereinabove.

Pharmaceutical compositions comprising one or more of the activeingredients described herein can therefore include, for example, the H₁agonist described herein and an agent for treating dyslipidemia (e.g.,cholesterol and/or triglyceride absorption inhibitor, cholesterol and/ortriglyceride biosynthesis inhibitor, ezetimibe, orlistat, a cholesterylester transfer protein (CETP) inhibitor, a bile acid sequesterant, afibrate, an HMG-CoA reductase inhibitor, a squalene inhibitor, nicotinicacid, a derivative, analog and metabolite thereof, and any mixturethereof, as is detailed hereinabove); the H₁ agonist described hereinand a drug associated with weight gain (e.g., an antipsychotic, anantidepressant, a mood-stabilizer, a calcium channel blocker, ananti-convulsant, a proton pump inhibitor, an antidiabetic agent, anantihypertensive, a hormone, an anti-smoking medication and anycombination thereof, as is detailed hereinabove); the H₁ agonistsdescribed herein and a weight control agent (e.g., Sibrutamine,Orlistat, Rimonabant, and more, as is detailed hereinabove); the H₁agonist described herein and agent for treating diabetes, and the like.

The purpose of a pharmaceutical composition is to facilitateadministration of an active ingredient (herein the H₁ agonist describedabove, optionally combined with other active ingredients) to an organism(herein, a human being). Pharmaceutical compositions of the presentinvention may be manufactured by processes well known in the art, e.g.,by means of conventional mixing, dissolving, granulating, dragee-making,levigating, emulsifying, encapsulating, entrapping or lyophilizingprocesses.

Such pharmaceutical carriers can be sterile liquids, such as water andoils, including those of petroleum, animal, vegetable or syntheticorigin, such as peanut oil, soybean oil, mineral oil, sesame oil and thelike. Water is a preferred carrier when the pharmaceutical compositionis administered intravenously. Saline solutions and aqueous dextrose andglycerol solutions can also be employed as liquid carriers, particularlyfor injectable solutions.

Suitable pharmaceutical excipients include without limitation, calciumcarbonate, calcium phosphate, various sugars and types of starch,cellulose derivatives, gelatin, vegetable oils, polyethylene glycols,sodium stearate, glycerol monostearate, talc, sodium chloride, glycerol,propylene, glycol, water, ethanol and the like. The composition, ifdesired, can also contain minor amounts of wetting or emulsifyingagents, or pH buffering agents. These compositions can take the form ofsolutions, suspensions, emulsion, tablets, pills, capsules, powders,sustained-release formulations and the like.

Further techniques for formulation and administration of activeingredients may be found in “Remington's Pharmaceutical Sciences,” MackPublishing Co., Easton, Pa., latest edition, which is incorporatedherein by reference as if fully set forth herein.

The pharmaceutical compositions herein described may also comprisesuitable solid or gel phase carriers or excipients. Examples of suchcarriers or excipients include, but are not limited to, calcium(carbonate, calcium phosphate, various sugars, starches, cellulosederivatives, gelatin and polymers such as polyethylene glycols.

Pharmaceutical compositions for use in accordance with the presentinvention thus may be formulated in conventional manner using one ormore pharmaceutically acceptable carriers comprising excipients andauxiliaries, which facilitate processing of the active ingredients intopreparations which, can be used pharmaceutically. Proper formulation isdependent upon the route of administration chosen.

Pharmaceutical compositions that comprise two or more active ingredient,as described hereinabove, can be formulated either as a single packagedpharmaceutical dose unit (further referred to herein as a “unitarydosage form”) that includes the two or more active ingredients or as twoor more separate units (e.g. two or more dosage forms) each including asingle active ingredient and all preferably further packaged into asingle delivery device (e.g., a capsule).

Since the H₁ agonist described herein is characterized by a desirablepharmacokinetic, reflected by a timed plasma peak concentration, thecomposition of the present invention is formulated such that the maximalefficacy of the active ingredients would provide an optimal effect withregard to the intended use of the combined composition.

Preferably, the composition of the present invention is formulated suchthat a plasma peak concentration of each of the active ingredientsoccurs substantially simultaneously. Thus, for example, compositionscomprising one or more drugs associated with weight gain and the H₁agonist described herein are formulated such that the plasma peakconcentration of the H₁ agonist would occur within the time frame inwhich the plasma concentration of the drug causes appetite stimulation.

One approach for achieving the above, is to attenuate the release of theH₁ agonist with respect to the release of the other active ingredient(s)or, vice versa, attenuate the release of the other active ingredient(s)with respect to the release of the H₁ agonist. In order to achieve suchstaggered release, both agents may be in delayed release form of varyingrelease profile, or one agent may be in immediate release form and theother agent(s) in delayed release form. In another approach, the agentsare delivered as individual pulses, at spaced-apart time intervals.

An exemplary formulation includes capsules housing tablets ordrug-containing beads or particles, a first portion of which comprisesthe H₁ agonist, and a second portion of which comprises another activeingredient, wherein each portion provides a different drug releaseprofile. The capsule material may be either hard or soft, and as will beappreciated by those skilled in the art of pharmaceutical science,typically comprises a tasteless, easily administered and water solublecompound such as gelatin, starch or cellulose.

A unitary dosage form may comprise a single tablet with the first andsecond dosage units each representing an integral and discrete layerthereof. For example, drug-containing particles or drug-containing beadscan be compressed together into a single tablet using conventionaltableting means.

Delayed release may be achieved by any method known in the art. As willbe appreciated by those skilled in the art, a number of methods areavailable for preparing drug-containing tablets or other dosage unitswhich provide a variety of drug release profiles. Such methods includecoating a drug or drug-containing composition, increasing the drug'sparticle size, placing the drug within a matrix, and forming complexesof the drug with a suitable complexing agent. Delayed release may beprovided, for example, by coating a drug or a drug-containingcomposition with a selected membrane coating material, typicallyalthough not necessarily a polymeric material. Exemplary delayed releaseforms of H₁ agonist preparations are described hereinabove.

When a coating is used to provide delayed release dosage units,particularly preferred coating materials comprise bioerodible, graduallyhydrolyzable and/or gradually water-soluble polymers. The “coatingweight,” or relative amount of coating material per dosage unit,generally dictates the time interval between ingestion and drug release.Suitable membrane coating materials for effecting delayed releaseinclude, but are not limited to: cellulosic polymers such ashydroxypropyl cellulose, hydroxyethyl cellulose, hydroxypropyl methylcellulose, methyl cellulose, ethyl cellulose, cellulose acetate,cellulose acetate phthalate, cellulose acetate trimellitate,hydroxypropylmethyl cellulose phthalate, cellulose ester-etherphthalate, hydroxypropylcellulose phthalate, alkali salts of celluloseacetate phthalate, alkaline earth salts of cellulose acetate phthalate,hydroxypropylmethyl cellulose hexahydrophthalate, cellulose acetatehexahydrophthalate, and carboxymethylcellulose sodium; acrylic acidpolymers and copolymers preferably formed from acrylic acid, methacrylicacid, acrylic acid alkyl esters, methacrylic acid alkyl esters, and thelike, e.g. copolymers of acrylic acid, methacrylic acid, methylacrylate, ethyl acrylate, methyl methacrylate and/or ethyl methacrylate,vinyl polymers and copolymers such as polyvinyl pyrrolidone, polyvinylacetate, polyvinylacetate phthalate, vinylacetate crotonic acidcopolymer, and ethylene-vinyl acetate copolymers; and shellac,ammoniated shellac, shellac-acetyl alcohol, and shellac n-butylstearate.

Alternatively, the delayed release, dosage units, e.g, tablets orparticles, may be formulated by dispersing the active ingredient withina matrix of a suitable material such as an insoluble plastic, ahydrophilic polymer, or a fatty compound. The insoluble plastic matricesmay be comprised of, for example, polyvinyl chloride or polyethylene.Hydrophilic polymers useful for providing a matrix for a delayed releasedosage unit include, but are not limited to, those described above assuitable coating materials. Fatty compounds for use as a matrix materialinclude, but are not limited to, waxes generally (e.g., carnauba wax)and glyceryl tristearate. Once the active ingredient is mixed with thematrix material, the mixture can be compressed into tablets or processedinto individual drug-containing particles.

Further examples of compositions in which one agent is delayed withrespect to the other agent include a formulation in which one agent isprovided in an outer, immediate release layer, which is released as afirst pulse, while the other agent is contained within a core which isseparated from the outer layer by a film layer of an enteric coating.The enteric coating slowly dissolves after the delivery of the firstpulse of drug allowing the release of the second pulse.

Formulations for oral delivery can include standard carriers such aspharmaceutical grades of mannitol, lactose, starch, magnesium stearate,sodium saccharine, cellulose, magnesium carbonate, etc. Examples ofsuitable pharmaceutical carriers are described in “Remington'sPharmaceutical Sciences” by E. W. Martin. Such compositions will containa therapeutically effective amount of the compound, preferably inpurified form, together with a suitable amount of carrier so as toprovide the form for proper administration to the patient. Theformulation should be suitable for the mode of administration.

For oral administration, the active ingredients can be formulatedreadily by combining the active ingredients with pharmaceuticallyacceptable carriers well known in the art. Such carriers enable theactive ingredients of the invention to be formulated as tablets, pills,dragees, capsules, liquids, gels, syrups, slurries, suspensions, and thelike, for oral ingestion by a patient. Pharmacological preparations fororal use can be made using a solid excipient, optionally grinding theresulting mixture, and processing the mixture of granules, after addingsuitable auxiliaries if desired, to obtain tablets or dragee cores.Suitable excipients are, in particular, fillers such as sugars,including lactose, sucrose, mannitol, or sorbitol; cellulosepreparations such as, for example, maize starch, wheat starch, ricestarch, potato starch, gelatin, gum tragacanth, methyl cellulose,hydroxypropylmethyl-cellulose, sodium carbomethylcellulose; and/orphysiologically acceptable polymers such as polyvinylpyrrolidone (PVP).If desired, disintegrating agents may be added, such as cross-linkedpolyvinyl pyrrolidone, agar, or alginic acid or a salt thereof such assodium alginate.

Dragee cores are provided with suitable coatings. For this purpose,concentrated sugar solutions may be used which may optionally containgum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethyleneglycol, titanium dioxide, lacquer solutions and suitable organicsolvents or solvent mixtures. Dyestuffs or pigments may be added to thetablets or dragee coatings for identification or to characterizedifferent combinations of active ingredient doses.

Pharmaceutical compositions, which can be used orally, include push-fitcapsules made of gelatin as well as soft, sealed capsules made ofgelatin and a plasticizer, such as glycerol or sorbitol. The push-fitcapsules may contain the active ingredients in admixture with fillersuch as lactose, binders such as starches, lubricants such as talc ormagnesium stearate and, optionally, stabilizers. In soft capsules, theactive ingredients may be dissolved or suspended in suitable liquids,such as fatty oils, liquid paraffin, or liquid polyethylene glycols. Inaddition, stabilizers may be added. All formulations for oraladministration should be in dosages suitable for the chosen route ofadministration.

For transdermal administration, the composition can be formulated in aform of a gel, a cream, an ointment, a paste, a lotion, a milk, asuspension, an aerosol, a spray, a foam, a serum, a swab, a pledget, apad or a patch. Formulations for transdermal delivery can typicallyinclude carriers such as water, liquid alcohols, liquid glycols, liquidpolyalkylene glycols, liquid esters, liquid amides, liquid proteinhydrolysates, liquid alkylated protein hydrolysates, liquid lanolin,lanolin derivatives, glycerin, mineral oil, silicone, petroleum jelly,lanolin, fatty acids, vegetable oils, parabens, waxes, and likematerials commonly employed in topical compositions. Various additives,known to those skilled in the art, may be included in the transdermalformulations of the invention. For example, solvents may be used tosolubilize certain active ingredients substances. Other optionaladditives include skin permeation enhancers, opacifiers, anti-oxidants,gelling agents, thickening agents, stabilizers, and the like.

For buccal administration, the compositions may take the form of tabletsor lozenges formulated in conventional mariner.

For administration by inhalation, the active ingredients for useaccording to the present invention are conveniently delivered in theform of an aerosol spray presentation from a pressurized pack or anebulizer with the use of a suitable propellant, e.g.,dichlorodifluoromethane, trichlorofluoromethane,dichloro-tetrafluoroethane or carbon dioxide. In the case of apressurized aerosol, the dosage unit may be determined by providing avalve to deliver a metered amount. Capsules and cartridges of, e.g.,gelatin for use in an inhaler or insufflator may be formulatedcontaining a powder mix of the active ingredient and a suitable powderbase such as lactose or starch.

The active ingredients described herein may be formulated for parenteraladministration, e.g., by bolus injection or continuous infusion.Formulations for injection may be presented in unit dosage form, e.g.,in ampoules or in multidose containers with optionally, an addedpreservative. The compositions may be suspensions, solutions oremulsions in oily or aqueous vehicles, and may contain formulatoryagents such as suspending, stabilizing and/or dispersing agents.

Pharmaceutical compositions for parenteral administration includeaqueous solutions of the active preparation in water-soluble form.Additionally, suspensions of the active ingredients may be prepared asappropriate oily injection suspensions. Suitable lipophilic solvents orvehicles include fatty oils such as sesame oil, or synthetic fatty acidsesters such as ethyl oleate, triglycerides or liposomes. Aqueousinjection suspensions may contain substances, which increase theviscosity of the suspension, such as sodium carboxymethyl cellulose,sorbitol or dextran. Optionally, the suspension may also containsuitable stabilizers or agents which increase the solubility of theactive ingredients to allow for the preparation of highly concentratedsolutions.

The composition can be formulated as rectal compositions such assuppositories or retention enemas, using, (e.g., conventionalsuppository bases such as cocoa butter or other glycerides.

The pharmaceutical compositions herein described may also comprisesuitable solid of gel phase carriers or excipients. Examples of suchcarriers or excipients include, but are not limited to, calciumcarbonate, calcium phosphate, various sugars, starches, cellulosederivatives, gelatin and polymers such as polyethylene glycols.

Compositions of the present invention may, if desired, be presented in apack or dispenser device, such as an FDA approved kit, which may containone or more unit dosage forms containing the active ingredient. The packmay, for example, comprise metal or plastic foil, such as a blisterpack. The pack or dispenser device may be accompanied by instructionsfor administration. The pack or dispenser may also be accompanied by anotice associated with the container in a form prescribed by agovernmental agency regulating the manufacture, use or sale ofpharmaceuticals, which notice is reflective of approval by the agency ofthe form of the compositions or human or veterinary administration. Suchnotice, for example, may be of labeling approved by the U.S. Food andDrug Administration for prescription drugs or of an approved productinsert. Compositions comprising the H₁ agonist of the invention, andoptionally other active ingredients, formulated in a compatiblepharmaceutical carrier may also be prepared, placed in an appropriatecontainer, and labeled for treatment of an indicated condition, as isdetailed herein.

Thus, for example, pharmaceutical compositions comprising the H₁ agonistof the invention and a drug that a treatment herewith is associated withweight gain (e.g., an antipsychotic), can be packaged in a packagingmaterial and identified in print, in or on the packaging material, foruse in the treatment of a condition for which the drug indicated, whilereducing or preventing weight gain associated with this drug treatment,as is detailed hereinabove.

Pharmaceutical compositions comprising the H₁ agonist of the invention,a cholesterol and/or triglycerides absorption inhibitor and/or acholesterol and/or triglycerides biosynthesis inhibitor can be packagedin a packaging material and identified in print, in or on the packagingmaterial, for use in the treatment of a condition associated withmetabolic derangement (e.g., dyslipidemia), as is detailed hereinabove.

Additional objects, advantages, and novel features of the presentinvention will become apparent to one ordinarily skilled in the art uponexamination of the following examples, which are not intended to belimiting. Additionally, each of the various embodiments and aspects ofthe present invention as delineated hereinabove and as claimed in theclaims section below finds experimental support in the followingexamples.

EXAMPLES

Reference is now made to the following example, which together with theabove descriptions, illustrate the invention in a non limiting fashion.

Example 1

The following study was conducted to evaluate the effect of oraladmisnitration of betahistine on food intake:

Twenty obese but otherwise healthy persons were recruited. Theircharacteristics upon recruitment are shown in Table 1. Exclusioncriteria for the study were age younger than 18, active diseases,medication use, known hypersensitivity or contra-indication for the useof betahistine.

Each subject was randomly allocated to receive betahistine 16 mg at10:00 and 16:00 or placebo. Weight, caloric intake (24 hour recall) andappetite during the day (VAS, Visual Analogue Score) were obtained onday 0, 14 and 28 of the study. Subjects were instructed to eat accordingto their appetite without limitations.

Statistical significance was assessed with t-test. BMI stands for bodymass index. TABLE 1 Patients' characteristics Treatment betahistinePlacebo Age 48 ± 9  38 ± 15 NS Weight (kg) 93 ± 17 90 ± 4  NS BMI 35.1 ±7.3  32.7 ± 1.7  NS Mean caloric intake (kcal) 975 ± 472 1397 ± 693  NSMean appetite score (VAS) 45 ± 15 50 ± 12 NSNS denotes no statistical significance (p value > 0.05)

Of the 20 subjects recruited, 8 did not complete the study and wereexcluded from the final analysis:

Subject No. 3 (placebo) dropped out on day 3 due to sideeffects—weakness.

Subject No. 5 (betahistine) reported on day 5 food aversion that did notallow her to consume any food. She was instructed to reduce the dose byhalf and was excluded from the results analysis.

Subject No. 9 (placebo) was excluded for protocol violation.

Subject No. 11 (placebo) dropped out on week 4 due to flu.

Subject No. 13 (placebo) was lost to follow up.

Subject No. 15 (betahistine) dropped out on week 4 due to flu.

Subject No. 16 (placebo) dropped out on week 3 due to dyspnea.

Subject No. 17 (betahistine) was lost to follow up.

The effect of betahistine treatment on the total caloric intake, and onthe specific consumption of fat, carbohydrates and protein of theparticipants in this study was also studied. The obtained data arepresented in FIGS. 4 and 5.

As can be seen in FIG. 4, treatment with betahistine was found to reducetotal caloric intake as compared to the placebo. The caloric intakedecreased to 80 percents of the pre-treatment level at day 14 oftreatment, and to 68 percents at day 28. No decrease was seen with thesubjects receiving placebo.

As can be seen in FIG. 5, while only a small reduction in carbohydrateconsumption occurred with betahistine treatment (6%), fat and proteinconsumption were reduced by 49% and 35%, respectively. At the same timepatients treated with placebo increased their carbohydrates, fats andprotein consumption by 24%, 3% and 37% respectively.

It is therefore clearly shown that betahistine significantly reduces thecaloric intake and fat consumption of a human subject. Therefore,administration of betahistine may be efficiently utilized for bothimproving compliance of a human subject to caloric restriction, and forreducing the desire of a human subject to consume fat.

The effect of betahistine administration on weight change was alsostudied. The results are presented in FIG. 6. Four out of seven subjectsin the treatment group lost more than 1 kg during the study period, incomparison to only one out of five in the placebo group.

These clinical data clearly show that betahistine is an efficientmedication for weight management.

Example 2

In a further study, a healthy, overweight woman was treated twice dailywith betahistine 16 mg for a month without any dietary changes. Thelevel of certain metabolites of the woman, as observed in blood tests,was measured before and after the betahistine treatment and arepresented in Table 2 below. TABLE 2 Day 0 Day 30 Change Totalcholesterol 167 155 −7% HDL-cholesterol 54 58 +7% LDL-cholesterol 99 84−15%  Triglycerides 69 62 −10%  Fructoseamine 195 202 +4%

As seen in Table 2, the results show that during the 30-day time periodstudied, the total cholesterol level of the subject decreased, with acorresponding decrease in the level of LDL-cholesterol and an increasein the level of HDL-cholesterol. The level of triglycerides decreased,while the level of fructoseamine increased very slightly. It istherefore concluded that the subject restricted her fat intake, (asshown by the decrease in LDL-cholesterol), without reducing hercarbohydrate intake, (as shown by the slight increase in fructosaminelevel), indicating that betahistine has a specific effect on reducingfat intake in a human subject.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate, embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated in their entirety by referenceinto the specification, to the same extent as if each individualpublication, patent or patent application was specifically andindividually indicated to be incorporated herein by reference. Inaddition, citation or identification of any reference in thisapplication shall not be construed as an admission that such referenceis available as prior art to the present invention.

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1. A pharmaceutical composition comprising a therapeutically effectiveamount of an H₁ agonist and a therapeutically effective amount of anagent for treating a condition associated with adverse imbalance of alevel of a metabolite, said metabolite being selected from the groupconsisting of total cholesterol, high density lipoprotein-cholesterol,low-density lipoprotein-cholesterol and a triglyceride.
 2. Thepharmaceutical composition of claim 1, wherein said H₁ agonist isbetahistine or a pharmaceutically acceptable salt thereof.
 3. Thepharmaceutical composition of claim 2, wherein said H₁ agonist is abetahistine metabolite.
 4. The pharmaceutical composition of claim 3,wherein said betahistine metabolite is 2-(2-aminoethyl)-pyridin(e. 5.The pharmaceutical composition of claim 2, wherein said betahistine saltis selected from the group consisting of betahistine dihydrochloride,betahistine mesilate, and betahistine trimebutine maleate.
 6. Thepharmaceutical composition of claim 2, wherein said H₁ agonist is abetahistine derivative.
 7. The pharmaceutical composition of claim 6,wherein said betahistine derivative is selected from the group ofcompounds represented by formula I:

wherein each of R₁-R₁₂ is independently selected from the groupconsisting of hydrogen, alkyl, cycloalkyl and aryl.
 8. Thepharmaceutical composition of claim 1, wherein said therapeuticallyeffective amount ranges from about 2 mg to about 96 mg.
 9. Thepharmaceutical composition of claim 1, being formulated such that saidH₁ agonist is in a slow-release form.
 10. The pharmaceutical compositionof claim 1, wherein said agent for treating said condition associatedwith said adverse imbalance is an agent for treating dyslipidemia. 11.The pharmaceutical composition of claim 10, wherein said agent fortreating dyslipidemia is selected from the group consisting ofcholesterol and/or triglyceride absorption inhibitor, cholesterol and/ortriglyceride biosynthesis inhibitor, ezetimibe, orlistat, a cholesterylester transfer protein (CETP) inhibitor, a bile acid sequesterant, afibrate, an HMG-CoA reductase inhibitor, a squalene inhibitor, nicotinicacid, a derivative, analog and metabolite thereof, and any mixturethereof.
 12. The pharmaceutical composition of claim 1, being packagedin a packaging material and identified in print, in or on said packagingmaterial, for use in the treatment of a condition associated withadverse imbalance of a level of a metabolite in a human subject, saidmetabolite being selected from the group consisting of totalcholesterol, high density lipoprotein-cholesterol, low-densitylipoprotein-cholesterol and a triglyceride.
 13. The pharmaceuticalcomposition of claim 12, wherein said condition is associated with highfat consumption.
 14. The pharmaceutical composition of claim 13, whereinsaid condition is dyslipidemia.
 15. The pharmaceutical composition ofclaim 13, wherein said condition is hypercholesterolemia.
 16. Thepharmaceutical composition of claim 12, being identified for use inreducing total cholesterol level in a human subject.
 17. Thepharmaceutical composition of claim 12, being identified for use inreducing low-density lipoprotein cholesterol and increasing high-densitylipoprotein cholesterol levels in a human subject.
 18. Thepharmaceutical composition of claim 12, being identified for use inreducing triglyceride level in a human subject.